Provider Demographics
NPI:1326185505
Name:HEAIVILIN, CELESTE L
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:L
Last Name:HEAIVILIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 N ELM ST STE 108
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801-4509
Mailing Address - Country:US
Mailing Address - Phone:308-227-9271
Mailing Address - Fax:308-381-7970
Practice Address - Street 1:3180 W HIGHWAY 34
Practice Address - Street 2:AHEC OFFICE
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801-7279
Practice Address - Country:US
Practice Address - Phone:308-385-6428
Practice Address - Fax:308-385-6414
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7068101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100251308-00Medicaid