Provider Demographics
NPI:1144888132
Name:CASTILLO, NICOLE MARY (MA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARY
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7170 N FINANCIAL DR STE 110
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-2935
Mailing Address - Country:US
Mailing Address - Phone:559-691-6840
Mailing Address - Fax:559-468-6141
Practice Address - Street 1:7170 N FINANCIAL DR STE 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2935
Practice Address - Country:US
Practice Address - Phone:559-691-6840
Practice Address - Fax:559-468-6141
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140147106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist