Provider Demographics
NPI:1881780419
Name:CASTLEBERRY, ALICE MARIE (PSYD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:MARIE
Last Name:CASTLEBERRY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:CASTLEBERRY
Other - Last Name:NEUBAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 2536
Mailing Address - Street 2:PO BOX 561
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-7536
Mailing Address - Country:US
Mailing Address - Phone:830-928-5299
Mailing Address - Fax:
Practice Address - Street 1:327 EARL GARRETT ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4514
Practice Address - Country:US
Practice Address - Phone:830-522-2547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32485103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171650802Medicaid
TX8D2167Medicare PIN