Provider Demographics
NPI:1821540246
Name:CASTILLO, MARISELA (LCPC, LPC)
Entity Type:Individual
Prefix:
First Name:MARISELA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:MARISELA
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NUNEZ
Mailing Address - Street 1:4311 W BALANCE ROCK DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5411
Mailing Address - Country:US
Mailing Address - Phone:208-703-1995
Mailing Address - Fax:
Practice Address - Street 1:4311 W BALANCE ROCK DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5411
Practice Address - Country:US
Practice Address - Phone:208-703-1995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC 6291101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No101Y00000XBehavioral Health & Social Service ProvidersCounselor