MEDICARE: DR. LAKISHA MONIQUE CASTILLO BCBA

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	174400000X	Specialist
2	222Q00000X	Developmental Therapist
3	103K00000X	Behavior Analyst	1-23-65113	TX

General Provider Information

NPI Number	:	1598015653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAKISHA MONIQUE CASTILLO BCBA

Provider Business Mailing Address
First Line	:	1901 POST OAK PARK DR APT 5202
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-3344
Country	:	US
Telephone Number	:	321-948-8044
Fax Number	:

Provider Business Practice Location Address
First Line	:	2338 W ROYAL PALM RD STE J
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-9339
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

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

Provider Enumeration Date	:	09/17/2012
Last Update Date	:	04/24/2025

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