Healthcare Provider Details

I. General information

NPI: 1679354047
Provider Name (Legal Business Name): CELISE RAELYNN ENGEL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CELISE RAELYNN BULLARD SPRAGUE; WATKINS

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 BUCKEYE AVE STE 104
AMES IA
50010-8120
US

IV. Provider business mailing address

1103 BUCKEYE AVE STE 104
AMES IA
50010-8120
US

V. Phone/Fax

Practice location:
  • Phone: 515-954-9865
  • Fax: 515-335-0971
Mailing address:
  • Phone: 515-954-9865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: