Provider Demographics
NPI:1699841296
Name:MOSLEY, CELESTE
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:MR
Other - First Name:OSCAR
Other - Middle Name:
Other - Last Name:MOSLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8848 W GRISWOLD RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7819
Mailing Address - Country:US
Mailing Address - Phone:623-877-7821
Mailing Address - Fax:
Practice Address - Street 1:8848 W GRISWOLD RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7819
Practice Address - Country:US
Practice Address - Phone:623-877-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5846385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ813841OtherAHCCCS ID NUMBER