Healthcare Provider Details

I. General information

NPI: 1629447180
Provider Name (Legal Business Name): NICOLE DIANA CASTILLO LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 PINE AVE # 320
LONG BEACH CA
90802-2327
US

IV. Provider business mailing address

309 PINE AVE # 320
LONG BEACH CA
90802-2327
US

V. Phone/Fax

Practice location:
  • Phone: 949-478-1757
  • Fax:
Mailing address:
  • Phone: 949-478-1757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF99910
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPCC3844
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140140
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: