Provider Demographics
NPI:1124285101
Name:CASTANO, ANGELICA (LPC)
Entity type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:
Last Name:CASTANO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5427 W JONES AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-4759
Mailing Address - Country:US
Mailing Address - Phone:623-204-9384
Mailing Address - Fax:
Practice Address - Street 1:17100 N 67TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3698
Practice Address - Country:US
Practice Address - Phone:623-204-9384
Practice Address - Fax:602-938-1626
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2013-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13801101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional