Provider Demographics
NPI:1649611187
Name:PROSE, CELESTE ANGELITA (BA)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:ANGELITA
Last Name:PROSE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 NE HOYT ST STE B55
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2957
Mailing Address - Country:US
Mailing Address - Phone:503-233-5393
Mailing Address - Fax:503-659-8984
Practice Address - Street 1:5050 NE HOYT ST STE B55
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2957
Practice Address - Country:US
Practice Address - Phone:503-233-5393
Practice Address - Fax:503-659-8984
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
ORL104081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst