Provider Demographics
NPI:1912225061
Name:CASTRO, CARLA A (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:A
Last Name:CASTRO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:CARLA
Other - Middle Name:A
Other - Last Name:GRUNDHAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCPC
Mailing Address - Street 1:918 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-2017
Mailing Address - Country:US
Mailing Address - Phone:701-561-6033
Mailing Address - Fax:
Practice Address - Street 1:918 2ND AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-2017
Practice Address - Country:US
Practice Address - Phone:701-561-6033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-13
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5318104100000X
MTBBH-LCPC-LIC-43588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker