Healthcare Provider Details

I. General information

NPI: 1407738503
Provider Name (Legal Business Name): TONI CASTILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 N ADAMS ST
CARROLL IA
51401-2344
US

IV. Provider business mailing address

1317 IVA ST
IRVING TX
75060-5962
US

V. Phone/Fax

Practice location:
  • Phone: 712-525-0993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number133695
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number79176
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: