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General NPI Number Information
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NPI Number | 1497058184
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Entity Type | Organization
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Legal Business Name | LISA ANN CELOSSE
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Dates
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Enumeration Date | 12/17/2010
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 1925 ASPEN DR STE 302A
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City | SANTA FE
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State | NM
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Zip | 87505-5588
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Country | US
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Telephone | 505-720-9167
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 250
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City | CHIMAYO
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State | NM
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Zip | 87522-0250
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Country | US
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Telephone | 505-720-9167
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Fax |
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Authorized Official
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Title or Position | LPCC. LMFT
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Name | LISA A CELOSSE
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Credential | LPCC, LMFT
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Telephone | 505-720-9167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0091031
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | MFC38644
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 0104011
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License Number State | NM
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