Provider Demographics
NPI:1205325818
Name:CARRILLO, MARK J
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:CARRILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 EL DORADO AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3853
Mailing Address - Country:US
Mailing Address - Phone:925-323-9470
Mailing Address - Fax:
Practice Address - Street 1:STE CONSULTANTS, LLC
Practice Address - Street 2:3650 MT DIABLO BLVD., SUITE 107
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549
Practice Address - Country:US
Practice Address - Phone:510-665-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician