Provider Demographics
NPI:1740608959
Name:CASTRO, JOSE ALEJANDRO (LPC, LAC)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:CASTRO
Suffix:
Gender:M
Credentials:LPC, LAC
Other - Prefix:MR
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:CASTRO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, LAC
Mailing Address - Street 1:12487 E AMHERST CIR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3305
Mailing Address - Country:US
Mailing Address - Phone:303-667-3154
Mailing Address - Fax:
Practice Address - Street 1:10699 MELODY DR STE 2
Practice Address - Street 2:
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80234-4131
Practice Address - Country:US
Practice Address - Phone:303-252-4179
Practice Address - Fax:303-252-4186
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0001197101YA0400X, 101YA0400X
CO15-2804101YA0400X
COLPC.0012317101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000184095Medicaid