Provider Demographics
NPI:1265873624
Name:CASTANEDA, KALENA SUANN
Entity type:Individual
Prefix:MRS
First Name:KALENA
Middle Name:SUANN
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KALENA
Other - Middle Name:SUANN
Other - Last Name:CASTANEDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2513 BUCHANAN DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1270
Mailing Address - Country:US
Mailing Address - Phone:970-433-0248
Mailing Address - Fax:
Practice Address - Street 1:3198 F RD STE 103
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-4039
Practice Address - Country:US
Practice Address - Phone:970-779-4928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1265873624101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional