Provider Demographics
NPI:1588718597
Name:RIVERS, CELESTE (MA, LMHC)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:RIVERS
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1384
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292-1384
Mailing Address - Country:US
Mailing Address - Phone:360-629-2967
Mailing Address - Fax:360-629-0759
Practice Address - Street 1:10003 270TH ST NW
Practice Address - Street 2:SUITE C
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292-8093
Practice Address - Country:US
Practice Address - Phone:360-629-2967
Practice Address - Fax:360-629-0759
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005592101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health