Provider Demographics
NPI:1790460608
Name:CELESKI, KRISTEN (BHT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CELESKI
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:BRYANA
Other - Last Name:CELESKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10209 W RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-8304
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10209 W RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-8304
Practice Address - Country:US
Practice Address - Phone:480-616-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X, 247000000X
AZ175T00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No174H00000XOther Service ProvidersHealth Educator
No175T00000XOther Service ProvidersPeer Specialist
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information