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General NPI Number Information
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NPI Number | 1619331907
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Entity Type | Individual
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Provider Name | JOZABETH CASILLAS M.S., LMFT
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Gender | Female
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 12/04/2019
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Provider Practice Location Address
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Address Line | 1425 W FOOTHILL BLVD
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City | UPLAND
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State | CA
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Zip | 91786-8007
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Country | US
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Telephone | 909-993-4267
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Fax |
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Provider Business Mailing Address
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Address Line | 1425 W FOOTHILL BLVD
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City | UPLAND
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State | CA
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Zip | 91786-8007
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Country | US
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Telephone | 909-993-4267
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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 | IMF92334
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 116578
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License Number State | CA
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