Healthcare Provider Details

I. General information

NPI: 1598015653
Provider Name (Legal Business Name): LAKISHA MONIQUE CASTILLO BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2338 W ROYAL PALM RD STE J
PHOENIX AZ
85021-9339
US

IV. Provider business mailing address

1901 POST OAK PARK DR APT 5202
HOUSTON TX
77027-3344
US

V. Phone/Fax

Practice location:
  • Phone: 855-772-8847
  • Fax:
Mailing address:
  • Phone: 321-948-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-65113
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: