Provider Demographics
NPI:1942420369
Name:RILEY, CELESTE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:A
Last Name:RILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 E 29TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2603
Mailing Address - Country:US
Mailing Address - Phone:979-776-5602
Mailing Address - Fax:979-776-5265
Practice Address - Street 1:2900 E 29TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2603
Practice Address - Country:US
Practice Address - Phone:979-776-5602
Practice Address - Fax:979-776-5265
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33212103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling