=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831756212
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANGELICA CASTILLO LCPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/21/2019
-----------------------------------------------------
Last Update Date | 10/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 824 17TH AVE S STE 14
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83651-4780
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-254-1035
-----------------------------------------------------
Fax | 208-477-5203
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21 N SPICELAND PL
-----------------------------------------------------
City | NAMPA
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83687-3165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-254-1035
-----------------------------------------------------
Fax | 208-477-5203
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | LCPC-9024
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------