Healthcare Provider Details

I. General information

NPI: 1487578639
Provider Name (Legal Business Name): MARIAH J CASTRO AMFT, APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

588 MULBERRY CIR
MANTECA CA
95337-5326
US

IV. Provider business mailing address

588 MULBERRY CIR
MANTECA CA
95337-5326
US

V. Phone/Fax

Practice location:
  • Phone: 209-321-1789
  • Fax:
Mailing address:
  • Phone: 209-321-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPCC23155
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT164372
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: