Provider Demographics
NPI:1871156901
Name:CASTRO, MICAYLA T (BA)
Entity type:Individual
Prefix:
First Name:MICAYLA
Middle Name:T
Last Name:CASTRO
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 W RESERVOIR RD APT 302
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-7727
Mailing Address - Country:US
Mailing Address - Phone:970-415-6581
Mailing Address - Fax:
Practice Address - Street 1:710 11TH AVE STE L46
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-3171
Practice Address - Country:US
Practice Address - Phone:970-415-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health