Healthcare Provider Details

I. General information

NPI: 1114912318
Provider Name (Legal Business Name): CELIA L STOLTZ PHD, PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CELIA SHINKLE

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date: 03/23/2006
Reactivation Date: 04/11/2006

III. Provider practice location address

12890 QUINTA WAY
DESERT HOT SPRINGS CA
92240-4852
US

IV. Provider business mailing address

12890 QUINTA WAY
DESERT HOT SPRINGS CA
92240-4852
US

V. Phone/Fax

Practice location:
  • Phone: 760-329-2924
  • Fax:
Mailing address:
  • Phone: 760-329-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15637
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number180-002919
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberPSB94023901
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: