Provider Demographics
NPI:1356628549
Name:CASTANEDA, ELIZABETH CASTRO (MS, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CASTRO
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:MS, LPC, NCC
Other - Prefix:MRS
Other - First Name:LIZA
Other - Middle Name:
Other - Last Name:CASTANEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC, NCC
Mailing Address - Street 1:609 S H ST
Mailing Address - Street 2:
Mailing Address - City:RUPERT
Mailing Address - State:ID
Mailing Address - Zip Code:83350-2044
Mailing Address - Country:US
Mailing Address - Phone:208-431-1716
Mailing Address - Fax:
Practice Address - Street 1:1334 MILLER AVE
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-1729
Practice Address - Country:US
Practice Address - Phone:208-312-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4820101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional