Basic Information
| Provider Information | |||||||||
| NPI: | 1285298125 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTELLANO-HSIA | ||||||||
| FirstName: | MARIA | ||||||||
| MiddleName: | ELENA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | ALMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 177 | ||||||||
| Address2: | |||||||||
| City: | AVILA BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934240177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055565176 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 676 PISMO ST | ||||||||
| Address2: | |||||||||
| City: | SAN LUIS OBISPO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934013945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055437969 | ||||||||
| FaxNumber: | 8055430859 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2019 | ||||||||
| LastUpdateDate: | 04/25/2019 | ||||||||
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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 | 106H00000X | AMFT107279 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.