Provider Demographics
NPI:1518475714
Name:CASTILLO, CYNTHIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CASTILLO
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 1:4009 BANISTER LN STE 355
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7040
Mailing Address - Country:US
Mailing Address - Phone:512-712-2662
Mailing Address - Fax:
Practice Address - Street 1:4009 BANISTER LN STE 355
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7040
Practice Address - Country:US
Practice Address - Phone:512-712-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-22
Last Update Date:2023-08-08
Deactivation Date:2021-05-21
Deactivation Code:
Reactivation Date:2021-06-10
Provider Licenses
StateLicense IDTaxonomies
TX79116101YP2500X, 101YM0800X
TX106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health