Provider Demographics
NPI:1629186259
Name:SPANE, CELESTE (LPC)
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:
Last Name:SPANE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N. 6TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85003
Mailing Address - Country:US
Mailing Address - Phone:602-234-0541
Mailing Address - Fax:602-462-1119
Practice Address - Street 1:810 N 6TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-1318
Practice Address - Country:US
Practice Address - Phone:602-234-0541
Practice Address - Fax:602-462-1119
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 0716101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health