Basic Information
| Provider Information | |||||||||
| NPI: | 1255531414 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTLE | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | MA, PCC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 521 BEALL AVE | ||||||||
| Address2: | |||||||||
| City: | WOOSTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446913589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302627836 | ||||||||
| FaxNumber: | 3302622867 | ||||||||
| Practice Location | |||||||||
| Address1: | 625 CLEVELAND AVE NW | ||||||||
| Address2: | |||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447021805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304550374 | ||||||||
| FaxNumber: | 3304552101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 04/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | C0501362 | OH | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | E 1700117 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 2584314 | 05 | OH | MEDICAID |