Provider Demographics
NPI:1003388224
Name:HAYNES, CELESTE (LCPC, NCC, BCC, MAC)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:LCPC, NCC, BCC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 W WEST END AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-3515
Mailing Address - Country:US
Mailing Address - Phone:708-715-0867
Mailing Address - Fax:
Practice Address - Street 1:4921 W WEST END AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-3515
Practice Address - Country:US
Practice Address - Phone:708-715-0867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180011681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty