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General NPI Number Information
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NPI Number | 1396182713
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Entity Type | Individual
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Provider Name | TONIA MARIE CASTILLEJA MS, QMHP
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Gender | Female
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Dates
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Enumeration Date | 05/24/2013
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 3886 BEVERLY AVE NE STE 6
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City | SALEM
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State | OR
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Zip | 97305-1373
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Country | US
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Telephone | 541-342-5088
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Fax |
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Provider Business Mailing Address
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Address Line | 3886 BEVERLY AVE NE STE 6
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City | SALEM
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State | OR
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Zip | 97305-1373
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Country | US
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Telephone | 541-342-5088
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 08-03-04
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R8536
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | R8536
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License Number State | OR
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