MEDICARE: JEAN M CASTLE LPC

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	101YM0800X	Mental Health Counselor	89552	TX

General Provider Information

NPI Number	:	1619688801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN M CASTLE LPC

Provider Business Mailing Address
First Line	:	1907 MORROW ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-6013
Country	:	US
Telephone Number	:	940-642-8621
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 MORROW ST
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-6013
Country	:	US
Telephone Number	:	940-642-8621
Fax Number	:

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

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	12/22/2022

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Directions to “ JEAN M CASTLE LPC” Practice Location

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