Provider Demographics
NPI:1790304582
Name:CASTANEDA, CARLOS JESUS JR (LPC)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:JESUS
Last Name:CASTANEDA
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 MENCHACA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6746
Mailing Address - Country:US
Mailing Address - Phone:512-877-4559
Mailing Address - Fax:
Practice Address - Street 1:4022 MENCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-6746
Practice Address - Country:US
Practice Address - Phone:128-774-5595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-11
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor