Provider Demographics
NPI:1295463958
Name:MONTAGUE-CASILLAS, THOMAS STEPHEN
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:STEPHEN
Last Name:MONTAGUE-CASILLAS
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 1:824 VALE CT
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-4844
Mailing Address - Country:US
Mailing Address - Phone:419-806-6856
Mailing Address - Fax:
Practice Address - Street 1:5565 AIRPORT HWY STE 100&203
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-7379
Practice Address - Country:US
Practice Address - Phone:419-720-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health