Provider Demographics
NPI:1649769712
Name:CASTILLO, MELINA (LCSW)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MELINA
Other - Middle Name:
Other - Last Name:AGUILAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 CONOVER DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-1519
Mailing Address - Country:US
Mailing Address - Phone:214-266-3416
Mailing Address - Fax:
Practice Address - Street 1:801 CONOVER DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75051-1519
Practice Address - Country:US
Practice Address - Phone:214-266-3416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX388111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty