Provider Demographics
NPI:1588851224
Name:CASTILLO, GRACE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:MARIE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1311 CHISHOLM TRL STE 301
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2969
Mailing Address - Country:US
Mailing Address - Phone:512-593-1332
Mailing Address - Fax:512-248-9833
Practice Address - Street 1:1311 CHISHOLM TRL STE 301
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2969
Practice Address - Country:US
Practice Address - Phone:512-593-1332
Practice Address - Fax:512-248-9833
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2017-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000092191041C0700X
TX254681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical