Provider Demographics
NPI:1538918412
Name:GIJON-CASTANON, YAZARETH
Entity type:Individual
Prefix:MISS
First Name:YAZARETH
Middle Name:
Last Name:GIJON-CASTANON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:YAZARETH
Other - Middle Name:
Other - Last Name:GIJON-CASTANON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:167 STRICKLIN AVE.
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057
Mailing Address - Country:US
Mailing Address - Phone:256-469-8493
Mailing Address - Fax:
Practice Address - Street 1:167 STRICKLIN AVENUE
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35057
Practice Address - Country:US
Practice Address - Phone:256-469-8493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALRBT-22-224324106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician