Provider Demographics
NPI:1609957109
Name:AVALON, CELESTE JOY (MA)
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:JOY
Last Name:AVALON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:CECILIA
Other - Middle Name:JOYCE
Other - Last Name:WOODYARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:3393 IRIS AVE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-5205
Mailing Address - Country:US
Mailing Address - Phone:303-851-1205
Mailing Address - Fax:303-664-0785
Practice Address - Street 1:3393 IRIS AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-5205
Practice Address - Country:US
Practice Address - Phone:303-851-1205
Practice Address - Fax:303-664-0785
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLMFT #405106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
7136110OtherAETNA
336854OtherVALUE OPTIONS