Provider Demographics
NPI:1023255072
Name:CASTRO, THOMAS ISAAC (MFTI)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ISAAC
Last Name:CASTRO
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 W WALNUT AVE STE B
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-6233
Mailing Address - Country:US
Mailing Address - Phone:559-627-1490
Mailing Address - Fax:
Practice Address - Street 1:1750 W WALNUT AVE STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-6233
Practice Address - Country:US
Practice Address - Phone:559-627-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health