Provider Demographics
NPI:1780027748
Name:SCARBOROUGH, CELESTE (MS, RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:
Last Name:SCARBOROUGH
Suffix:
Gender:F
Credentials:MS, RD, LD
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RD, LD
Mailing Address - Street 1:2600 SAINT MICHAEL DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-5220
Mailing Address - Country:US
Mailing Address - Phone:903-614-5322
Mailing Address - Fax:
Practice Address - Street 1:2600 SAINT MICHAEL DR
Practice Address - Street 2:SUITE 311
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-5220
Practice Address - Country:US
Practice Address - Phone:903-614-5322
Practice Address - Fax:903-614-5354
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-09
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82131133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered