Provider Demographics
NPI:1497058184
Name:LISA ANN CELOSSE
Entity Type:Organization
Organization Name:LISA ANN CELOSSE
Other - Org Name:LISA ANN CELOSSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LPCC. LMFT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CELOSSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC, LMFT
Authorized Official - Phone:505-720-9167
Mailing Address - Street 1:PO BOX 250
Mailing Address - Street 2:
Mailing Address - City:CHIMAYO
Mailing Address - State:NM
Mailing Address - Zip Code:87522-0250
Mailing Address - Country:US
Mailing Address - Phone:505-720-9167
Mailing Address - Fax:
Practice Address - Street 1:1925 ASPEN DR STE 302A
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5588
Practice Address - Country:US
Practice Address - Phone:505-720-9167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-17
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0104011251S00000X
NM0091031251S00000X
CAMFC38644251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health