Healthcare Provider Details

I. General information

NPI: 1083115661
Provider Name (Legal Business Name): CELSO EDWARD TEIXEIRA LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2018
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

342 JEFFERSON AVE
GLENCOE IL
60022-1824
US

IV. Provider business mailing address

342 JEFFERSON AVE
GLENCOE IL
60022-1824
US

V. Phone/Fax

Practice location:
  • Phone: 224-707-0720
  • Fax:
Mailing address:
  • Phone: 224-707-0720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178.013680
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: