Provider Demographics
NPI:1851989651
Name:CASTILLO, CHANTAL ROSE (LPC)
Entity type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:ROSE
Last Name:CASTILLO
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19330 S 208TH PL
Mailing Address - Street 2:
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-1615
Mailing Address - Country:US
Mailing Address - Phone:520-517-8223
Mailing Address - Fax:
Practice Address - Street 1:19330 S 208TH PL
Practice Address - Street 2:
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85142-1615
Practice Address - Country:US
Practice Address - Phone:520-517-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-23382101YP2500X, 101YM0800X
AZLAC-22006101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health