Healthcare Provider Details

I. General information

NPI: 1811916547
Provider Name (Legal Business Name): PAUL CASTILLO LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1719 MERRILL DR
LITTLE ROCK AR
72212-4009
US

IV. Provider business mailing address

2809 FOREST HOME RD
JONESBORO AR
72401-5320
US

V. Phone/Fax

Practice location:
  • Phone: 501-663-2199
  • Fax:
Mailing address:
  • Phone: 866-972-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP0102011
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: