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General NPI Number Information
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NPI Number | 1790955375
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Entity Type | Individual
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Provider Name | RICHARD CASTILLO FAJARDO MA, LPCC, NCC
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Gender | Male
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Dates
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Enumeration Date | 03/10/2008
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Last Update Date | 03/10/2008
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Provider Practice Location Address
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Address Line | 500 GOLD AVE SW FL 11
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City | ALBUQUERQUE
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State | NM
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Zip | 87102-3118
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Country | US
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Telephone | 505-385-4284
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Fax | 505-248-7298
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Provider Business Mailing Address
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Address Line | 6884 AUGUSTA HILLS DR NE
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City | RIO RANCHO
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State | NM
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Zip | 87144-8605
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Country | US
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Telephone | 505-385-4284
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Fax | 505-248-7298
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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 | 0074081
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License Number State | NM
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