Provider Demographics
NPI:1609605690
Name:CASTER, MARVIN DEWAYNE
Entity type:Individual
Prefix:MR
First Name:MARVIN
Middle Name:DEWAYNE
Last Name:CASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 LAGO DE ORO DR
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7061
Mailing Address - Country:US
Mailing Address - Phone:915-422-0674
Mailing Address - Fax:
Practice Address - Street 1:172 LAGO DE ORO DR
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-7061
Practice Address - Country:US
Practice Address - Phone:915-422-0674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health