Provider Demographics
NPI:1730562273
Name:CASTRILLON, KELLI LOUISE (CMHC)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:LOUISE
Last Name:CASTRILLON
Suffix:
Gender:F
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 W 3500 S STE E
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-2668
Mailing Address - Country:US
Mailing Address - Phone:801-979-1351
Mailing Address - Fax:801-904-2089
Practice Address - Street 1:3280 W 3500 S STE E
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-2668
Practice Address - Country:US
Practice Address - Phone:801-979-1351
Practice Address - Fax:801-904-2089
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-01
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9424722-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health