Provider Demographics
NPI:1750439378
Name:JAVADI, CELIA R (LSW, LCDC-III, PCC)
Entity type:Individual
Prefix:MS
First Name:CELIA
Middle Name:R
Last Name:JAVADI
Suffix:
Gender:F
Credentials:LSW, LCDC-III, PCC
Other - Prefix:
Other - First Name:CELIA
Other - Middle Name:ROSE
Other - Last Name:MOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCND, CIMHP
Mailing Address - Street 1:207 OLD HARRODS CREEK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2553
Mailing Address - Country:US
Mailing Address - Phone:502-625-5260
Mailing Address - Fax:
Practice Address - Street 1:207 OLD HARRODS CREEK RD STE 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2553
Practice Address - Country:US
Practice Address - Phone:502-625-5260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
529740246Z00000X
47190247200000X
82234175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other