Provider Demographics
NPI:1144896028
Name:CASTILLO, KRISTIN CERISE
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:CERISE
Last Name:CASTILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 SOMERSET CIR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6637
Mailing Address - Country:US
Mailing Address - Phone:682-521-0418
Mailing Address - Fax:
Practice Address - Street 1:322 SOMERSET CIR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6637
Practice Address - Country:US
Practice Address - Phone:682-521-0418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-01
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health