MEDICARE: CANDACE CASTILLE LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	35850	TX

General Provider Information

NPI Number	:	1427187426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDACE CASTILLE LCSW

Provider Business Mailing Address
First Line	:	26314 LONGMONT PARK LN
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-4836
Country	:	US
Telephone Number	:	832-545-0185
Fax Number	:	281-395-9132

Provider Business Practice Location Address
First Line	:	5420 DASHWOOD DR STE 103
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5333
Country	:	US
Telephone Number	:	832-545-0185
Fax Number	:	281-395-9132

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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