Provider Demographics
NPI:1467083253
Name:CASTANON, MANDALYN (LMHC, LPCC)
Entity type:Individual
Prefix:
First Name:MANDALYN
Middle Name:
Last Name:CASTANON
Suffix:
Gender:F
Credentials:LMHC, LPCC
Other - Prefix:
Other - First Name:MANDALYN
Other - Middle Name:
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4975 E BUTLER AVE APT 105
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-5018
Mailing Address - Country:US
Mailing Address - Phone:559-217-3945
Mailing Address - Fax:
Practice Address - Street 1:3003 N BLACKSTONE AVE STE 101B
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93703-1055
Practice Address - Country:US
Practice Address - Phone:765-896-5030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-30
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39004002A101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health