Provider Demographics
NPI:1053867747
Name:CARRILLO, CHASTITY (LPC)
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-4471
Mailing Address - Country:US
Mailing Address - Phone:469-256-8322
Mailing Address - Fax:
Practice Address - Street 1:114 E LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-4471
Practice Address - Country:US
Practice Address - Phone:469-256-8322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional