Provider Demographics
NPI:1649456690
Name:BENSKEY, CELESTE 'SUE' (MALLP)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:'SUE'
Last Name:BENSKEY
Suffix:
Gender:F
Credentials:MALLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 N MAIN ST
Mailing Address - Street 2:STE 205
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1249
Mailing Address - Country:US
Mailing Address - Phone:734-454-0155
Mailing Address - Fax:
Practice Address - Street 1:340 N MAIN ST
Practice Address - Street 2:STE 205
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1249
Practice Address - Country:US
Practice Address - Phone:734-454-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-20
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006780103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical