Healthcare Provider Details

I. General information

NPI: 1003725698
Provider Name (Legal Business Name): CELESTE VANDERBECK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

674 SCARLETT ST
FORNEY TX
75126-3960
US

IV. Provider business mailing address

674 SCARLETT ST
FORNEY TX
75126-3960
US

V. Phone/Fax

Practice location:
  • Phone: 817-320-4906
  • Fax:
Mailing address:
  • Phone: 817-320-4906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number206073
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: