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General NPI Number Information
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NPI Number | 1487461323
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Entity Type | Individual
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Provider Name | ANNALISE CASTOR
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Gender | Male
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 4455 ALLEN LN
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-2204
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Country | US
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Telephone | 702-385-1072
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Fax |
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Provider Business Mailing Address
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Address Line | 11028 MOUNT ROYAL AVE
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City | LAS VEGAS
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State | NV
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Zip | 89144-4484
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Country | US
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Telephone | 702-501-1311
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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