Provider Demographics
NPI:1740562198
Name:HOWARD, CECELIA ROSE (PMHNP)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:ROSE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:TALENT
Mailing Address - State:OR
Mailing Address - Zip Code:97540-0794
Mailing Address - Country:US
Mailing Address - Phone:541-890-0979
Mailing Address - Fax:541-636-0288
Practice Address - Street 1:1607 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2400
Practice Address - Country:US
Practice Address - Phone:541-890-0979
Practice Address - Fax:541-636-0288
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150120NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health