Provider Demographics
NPI:1417249228
Name:CASTILLO, CYNTHIA (LCPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:3017 W CHARLESTON BLVD STE 70
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102-1928
Mailing Address - Country:US
Mailing Address - Phone:702-823-3910
Mailing Address - Fax:702-823-1313
Practice Address - Street 1:3017 W CHARLESTON BLVD STE 70
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102-1928
Practice Address - Country:US
Practice Address - Phone:702-823-3910
Practice Address - Fax:702-823-1313
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCP5504101YM0800X
225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner