Provider Demographics
NPI:1053753491
Name:CASTILLO, JEANNETTE
Entity type:Individual
Prefix:MRS
First Name:JEANNETTE
Middle Name:
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 1:495 OCOEE HILLS CIR NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-4538
Mailing Address - Country:US
Mailing Address - Phone:256-504-1894
Mailing Address - Fax:423-370-1346
Practice Address - Street 1:495 OCOEE HILLS CIR NE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37323-4538
Practice Address - Country:US
Practice Address - Phone:256-504-1894
Practice Address - Fax:423-370-1346
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-13-14017103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst