Provider Demographics
NPI:1841936408
Name:CASTILLO, AMY DIANE (LPC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DIANE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 GARNAAS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2220
Mailing Address - Country:US
Mailing Address - Phone:512-797-5776
Mailing Address - Fax:
Practice Address - Street 1:1508 GARNAAS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2220
Practice Address - Country:US
Practice Address - Phone:512-797-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82732101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82732OtherDO NOT HAVE