Provider Demographics
NPI:1194478362
Name:CASTILLO, VICTORIA ALYSSA
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ALYSSA
Last Name:CASTILLO
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 1:15103 MASON RD STE C-1
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-6755
Mailing Address - Country:US
Mailing Address - Phone:832-653-4369
Mailing Address - Fax:
Practice Address - Street 1:15103 MASON RD STE C-1
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-6755
Practice Address - Country:US
Practice Address - Phone:832-653-4369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXRBT-21-193582106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician