Provider Demographics
NPI:1447781083
Name:CELIS, JESSICA MARIE
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE
Last Name:CELIS
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 1:632 SPANISH LANE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGSS
Mailing Address - State:NV
Mailing Address - Zip Code:31410-2428
Mailing Address - Country:US
Mailing Address - Phone:912-749-4848
Mailing Address - Fax:
Practice Address - Street 1:633 JACKLYN WAY
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-5780
Practice Address - Country:US
Practice Address - Phone:323-484-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst