Provider Demographics
NPI:1477989127
Name:CASTILLO, NAKISHA SUEELLEN (DMFT)
Entity Type:Individual
Prefix:DR
First Name:NAKISHA
Middle Name:SUEELLEN
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 S MEADOW LN
Mailing Address - Street 2:#67
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6400
Mailing Address - Country:US
Mailing Address - Phone:860-967-8736
Mailing Address - Fax:
Practice Address - Street 1:19-531 MCLANE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262
Practice Address - Country:US
Practice Address - Phone:760-288-4579
Practice Address - Fax:760-288-3752
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist