Provider Demographics
NPI:1902281322
Name:CASTILLO, JUAN CARLOS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CARLOS
Other - Middle Name:
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2616 BUDDY OWENS BLVD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6900
Mailing Address - Country:US
Mailing Address - Phone:956-800-5679
Mailing Address - Fax:956-322-4415
Practice Address - Street 1:2616 BUDDY OWENS BLVD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6900
Practice Address - Country:US
Practice Address - Phone:956-800-5679
Practice Address - Fax:956-322-4415
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-27
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
TX37418103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist