Basic Information
| Provider Information | |||||||||
| NPI: | 1912477092 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CASTILLO | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3636 N 1ST ST STE 162 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937266869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5994762166 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3636 N 1ST ST STE 162 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937266869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5594762166 | ||||||||
| FaxNumber: | 8445636035 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2018 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | AMFT109958 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | LMFT119323 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.