Provider Demographics
NPI:1982690970
Name:ARCHAMBAULT, CELA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CELA
Middle Name:M
Last Name:ARCHAMBAULT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 N CAMPBELL AVE
Mailing Address - Street 2:# 104
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-7305
Mailing Address - Country:US
Mailing Address - Phone:520-797-7246
Mailing Address - Fax:520-795-4249
Practice Address - Street 1:3100 N CAMPBELL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2315
Practice Address - Country:US
Practice Address - Phone:520-797-7246
Practice Address - Fax:520-795-4249
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-10-19
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
AZ3279103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ468836Medicaid
AZZ71253Medicare PIN