Provider Demographics
NPI:1134428766
Name:CASTILLO, IVETTE LAURA (PHD)
Entity type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:LAURA
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6565 WEST LOOP S
Mailing Address - Street 2:STE. 600
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3500
Mailing Address - Country:US
Mailing Address - Phone:713-592-8952
Mailing Address - Fax:713-592-9266
Practice Address - Street 1:12920 DAIRY ASHFORD RD
Practice Address - Street 2:STE. 105
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3177
Practice Address - Country:US
Practice Address - Phone:713-592-8952
Practice Address - Fax:713-592-9266
Is Sole Proprietor?:No
Enumeration Date:2011-03-22
Last Update Date:2013-06-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX32615103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX288984201Medicaid