Healthcare Provider Details

I. General information

NPI: 1841862786
Provider Name (Legal Business Name): CELESTE ZAVALA-NELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 ROAD 33
PASCO WA
99301-3218
US

IV. Provider business mailing address

2120 ROAD 33
PASCO WA
99301-3218
US

V. Phone/Fax

Practice location:
  • Phone: 509-521-9112
  • Fax:
Mailing address:
  • Phone: 509-521-9112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMC60665398
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: