Provider Demographics
NPI:1407467061
Name:CASTEEL, MARY REBECCA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:REBECCA
Last Name:CASTEEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W NAVARRE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46616-1368
Mailing Address - Country:US
Mailing Address - Phone:269-815-8090
Mailing Address - Fax:
Practice Address - Street 1:69045 M 62 STE B2
Practice Address - Street 2:
Practice Address - City:EDWARDSBURG
Practice Address - State:MI
Practice Address - Zip Code:49112-9150
Practice Address - Country:US
Practice Address - Phone:269-815-8090
Practice Address - Fax:269-775-7079
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-16
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional