Provider Demographics
NPI:1912370297
Name:ARRILLAGA, CASEY (LCDC)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:ARRILLAGA
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:PATRICK
Other - Middle Name:CASEY
Other - Last Name:ARRILLAGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCDC
Mailing Address - Street 1:25 PLEASANT VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-2330
Mailing Address - Country:US
Mailing Address - Phone:575-770-6180
Mailing Address - Fax:
Practice Address - Street 1:25 PLEASANT VALLEY RD
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-2330
Practice Address - Country:US
Practice Address - Phone:575-770-6180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12921101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)