Healthcare Provider Details

I. General information

NPI: 1023737558
Provider Name (Legal Business Name): CELINA SUSANA CASTILLO CHAVEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CELINA CASTILLO

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 SE 14TH AVE
PORTLAND OR
97214-2549
US

IV. Provider business mailing address

905 SE 14TH AVE
PORTLAND OR
97214-2549
US

V. Phone/Fax

Practice location:
  • Phone: 503-622-8964
  • Fax:
Mailing address:
  • Phone: 503-622-8964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: