Provider Demographics
NPI:1639243173
Name:MATASCASTILLO, CHERYL KAY (LMFT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:KAY
Last Name:MATASCASTILLO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CIVIC CENTER PLZ STE 205
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-7718
Mailing Address - Country:US
Mailing Address - Phone:507-345-4679
Mailing Address - Fax:
Practice Address - Street 1:2277 HIGHWAY 36 W STE 150
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-3830
Practice Address - Country:US
Practice Address - Phone:507-345-4769
Practice Address - Fax:952-435-6797
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1352106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNHP60847OtherHEALTH PARTNERS
MN625K8LEOtherBLUE CROSS BLUE SHIELD
MN628128100Medicaid