Provider Demographics
NPI:1922817188
Name:CASTILLO, ALEC STEPHEN (BS, RBT)
Entity type:Individual
Prefix:MR
First Name:ALEC
Middle Name:STEPHEN
Last Name:CASTILLO
Suffix:
Gender:M
Credentials:BS, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10877 S LAKE RUN RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84009-8729
Mailing Address - Country:US
Mailing Address - Phone:504-444-3551
Mailing Address - Fax:
Practice Address - Street 1:8031 S 700 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-0555
Practice Address - Country:US
Practice Address - Phone:877-222-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTRBT-24-361067106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician