Basic Information
| Provider Information | |||||||||
| NPI: | 1073925871 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTANEDA | ||||||||
| FirstName: | ROBERTO | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1835 | ||||||||
| Address2: | |||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780441835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567943160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3031 W IH 10 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782015159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102611000 | ||||||||
| FaxNumber: | 2107318678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2014 | ||||||||
| LastUpdateDate: | 12/08/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 67087 | TX | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | 67087 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 67087 | 01 | TX | LPC | OTHER |