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General NPI Number Information
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NPI Number | 1053753491
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Entity Type | Individual
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Provider Name | MRS. JEANNETTE CASTILLO
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Gender | Female
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Dates
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Enumeration Date | 07/26/2013
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Last Update Date | 03/20/2017
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Provider Practice Location Address
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Address Line | 495 OCOEE HILLS CIR NE
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City | CLEVELAND
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State | TN
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Zip | 37323-4538
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Country | US
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Telephone | 256-504-1894
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Fax | 423-370-1346
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Provider Business Mailing Address
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Address Line | 495 OCOEE HILLS CIR NE
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City | CLEVELAND
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State | TN
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Zip | 37323-4538
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Country | US
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Telephone | 256-504-1894
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Fax | 423-370-1346
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-14017
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License Number State | AL
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