Healthcare Provider Details

I. General information

NPI: 1336477637
Provider Name (Legal Business Name): CASTLE COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2009
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1327 S 18TH ST
NEW CASTLE IN
47362-2665
US

IV. Provider business mailing address

1327 S 18TH ST
NEW CASTLE IN
47362-2665
US

V. Phone/Fax

Practice location:
  • Phone: 765-593-0003
  • Fax: 765-593-0032
Mailing address:
  • Phone: 765-593-0003
  • Fax: 765-593-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number39002279A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRISTOPHER DAVID HUFFORD
Title or Position: OWNER
Credential: MA, LMHC
Phone: 765-593-0003