Provider Demographics
NPI:1134324643
Name:CHEATHAM, CELESTE L (MC, LPC)
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:L
Last Name:CHEATHAM
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51356
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85076-1356
Mailing Address - Country:US
Mailing Address - Phone:480-532-5638
Mailing Address - Fax:480-634-7465
Practice Address - Street 1:1845 SOUTH DOBSON ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-5613
Practice Address - Country:US
Practice Address - Phone:480-532-5638
Practice Address - Fax:480-634-7465
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-12683101YP2500X
AZ12683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional