Provider Demographics
NPI:1932673621
Name:SKAGGS, CELINA PAIGE
Entity Type:Individual
Prefix:
First Name:CELINA
Middle Name:PAIGE
Last Name:SKAGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10803 W 75TH TER APT 104
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66214-1131
Mailing Address - Country:US
Mailing Address - Phone:913-605-6703
Mailing Address - Fax:
Practice Address - Street 1:4866 W 135TH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66224-8715
Practice Address - Country:US
Practice Address - Phone:832-439-1896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
KSRBT-19-88335106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician