Provider Demographics
NPI:1598015653
Name:CASTILLO, LAKISHA MONIQUE (BCBA)
Entity Type:Individual
Prefix:MISS
First Name:LAKISHA
Middle Name:MONIQUE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 PALM GROVE DR
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:TX
Mailing Address - Zip Code:77578-1524
Mailing Address - Country:US
Mailing Address - Phone:321-948-8044
Mailing Address - Fax:
Practice Address - Street 1:65 PALM GROVE DR
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:TX
Practice Address - Zip Code:77578-1524
Practice Address - Country:US
Practice Address - Phone:321-948-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 222Q00000X
TX1-23-65113103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist