Provider Demographics
NPI:1649362856
Name:TREVINO, CELESTE MARIE (MS LCPC)
Entity type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:MARIE
Last Name:TREVINO
Suffix:
Gender:F
Credentials:MS LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 W DIVERSEY
Mailing Address - Street 2:#27
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:773-549-0149
Mailing Address - Fax:773-549-0149
Practice Address - Street 1:561 W DIVERSEY
Practice Address - Street 2:#207
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-549-0149
Practice Address - Fax:773-549-0149
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1800001465101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional