Provider Demographics
NPI:1902592371
Name:CASTANEDA, JACQUELINE (LPC)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5990 LOURDES BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-6911
Mailing Address - Country:US
Mailing Address - Phone:956-579-1803
Mailing Address - Fax:
Practice Address - Street 1:5990 LOURDES BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-6911
Practice Address - Country:US
Practice Address - Phone:956-579-1803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84578101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor