Provider Demographics
NPI:1952927840
Name:CASTILLO, YESSENIA (LAC)
Entity Type:Individual
Prefix:
First Name:YESSENIA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:YESSENIA
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:222 W BROWN RD APT 72
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3425
Mailing Address - Country:US
Mailing Address - Phone:602-812-0637
Mailing Address - Fax:
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD STE 123
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4263
Practice Address - Country:US
Practice Address - Phone:480-771-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health