Provider Demographics
NPI:1205118528
Name:CASTILLO, JESSICA LEIGH (MA, LPC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEIGH
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LEIGH
Other - Last Name:HAMEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 1102
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1102
Mailing Address - Country:US
Mailing Address - Phone:307-374-4014
Mailing Address - Fax:
Practice Address - Street 1:408 S MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-6247
Practice Address - Country:US
Practice Address - Phone:307-374-4014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY621101Y00000X
WYLPC-1366101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor