Provider Demographics
NPI:1356785901
Name:CASTOR, KATELEEN (LMHC)
Entity type:Individual
Prefix:MISS
First Name:KATELEEN
Middle Name:
Last Name:CASTOR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4393 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-4206
Mailing Address - Country:US
Mailing Address - Phone:727-674-8976
Mailing Address - Fax:
Practice Address - Street 1:4393 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-4206
Practice Address - Country:US
Practice Address - Phone:727-674-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health