Provider Demographics
NPI:1518455245
Name:CASTILLO PSYCHOLOGICAL, LLC
Entity Type:Organization
Organization Name:CASTILLO PSYCHOLOGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:575-527-0614
Mailing Address - Street 1:1605 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3124
Mailing Address - Country:US
Mailing Address - Phone:575-527-0614
Mailing Address - Fax:575-541-4062
Practice Address - Street 1:1605 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3124
Practice Address - Country:US
Practice Address - Phone:575-527-0614
Practice Address - Fax:575-541-4062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-27
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1107103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty