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General NPI Number Information
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NPI Number | 1720312283
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Entity Type | Individual
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Provider Name | MICHAEL JAMES CASILLAS LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/30/2009
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Last Update Date | 12/02/2014
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Provider Practice Location Address
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Address Line | 4260 STOCKTON DR SUITE A
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117-2915
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Country | US
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Telephone | 501-916-9129
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Fax | 501-916-9770
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Provider Business Mailing Address
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Address Line | 4260 STOCKTON DR SUITE A
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City | NORTH LITTLE ROCK
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State | AR
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Zip | 72117-2915
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Country | US
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Telephone | 501-916-9129
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Fax | 501-916-9129
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 29549
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3491-C
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License Number State | AR
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