Healthcare Provider Details

I. General information

NPI: 1740166180
Provider Name (Legal Business Name): CHRISTINA L CASTILLEJO LAC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: XHRIS L CASTILLEJO LAC, NCC

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 W ROOSEVELT ST
PHOENIX AZ
85003-1324
US

IV. Provider business mailing address

8102 N 19TH DR APT T236
PHOENIX AZ
85021-5135
US

V. Phone/Fax

Practice location:
  • Phone: 623-695-7980
  • Fax: 602-691-0233
Mailing address:
  • Phone: 480-747-1214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLAC-23612
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number4178114
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: