Provider Demographics
NPI:1982338208
Name:COLON ORTIZ, CELIZBETS (RBT)
Entity Type:Individual
Prefix:
First Name:CELIZBETS
Middle Name:
Last Name:COLON ORTIZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10521 E 43RD ST APT 612
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64133-7223
Mailing Address - Country:US
Mailing Address - Phone:787-244-6493
Mailing Address - Fax:
Practice Address - Street 1:4024 W 74TH ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66208-2943
Practice Address - Country:US
Practice Address - Phone:913-372-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-21-187364106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician