Provider Demographics
NPI:1194121137
Name:WILSON-CASTEEL, GARA
Entity type:Individual
Prefix:
First Name:GARA
Middle Name:
Last Name:WILSON-CASTEEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 FIVCO CT
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-6107
Mailing Address - Country:US
Mailing Address - Phone:606-928-3341
Mailing Address - Fax:606-928-4281
Practice Address - Street 1:59 FIVCO CT
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-6107
Practice Address - Country:US
Practice Address - Phone:606-928-3341
Practice Address - Fax:606-928-4281
Is Sole Proprietor?:No
Enumeration Date:2014-11-18
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1244101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional