Provider Demographics
NPI:1023731015
Name:BADILLO CASTILLO, VICTOR MANUEL (MSCP)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:MANUEL
Last Name:BADILLO CASTILLO
Suffix:
Gender:M
Credentials:MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4914 COOPER ROAD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-8651
Mailing Address - Country:US
Mailing Address - Phone:513-514-5971
Mailing Address - Fax:
Practice Address - Street 1:431 OHIO PIKE # 240N
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3375
Practice Address - Country:US
Practice Address - Phone:513-655-3541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2204604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health