Provider Demographics
NPI:1336839240
Name:CASTILLO, REBECCA RAQUEL
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RAQUEL
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 W ELFINDALE ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1295
Mailing Address - Country:US
Mailing Address - Phone:417-874-1906
Mailing Address - Fax:417-771-3723
Practice Address - Street 1:1721 W ELFINDALE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1295
Practice Address - Country:US
Practice Address - Phone:417-874-1906
Practice Address - Fax:417-771-3723
Is Sole Proprietor?:No
Enumeration Date:2023-05-12
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst