Provider Demographics
NPI:1669579827
Name:CELAYA-FORBES, CONSTANCE YVETTE (PHD)
Entity type:Individual
Prefix:MS
First Name:CONSTANCE
Middle Name:YVETTE
Last Name:CELAYA-FORBES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:CONSTANCE
Other - Middle Name:YVETTE
Other - Last Name:CELAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:9820 LAKE HAVEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108
Mailing Address - Country:US
Mailing Address - Phone:817-246-1249
Mailing Address - Fax:
Practice Address - Street 1:1245 SOUTHRIDGE CRT
Practice Address - Street 2:#100 TEB PSYCHOLOGICAL ASSOCIATES PG
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053
Practice Address - Country:US
Practice Address - Phone:817-282-3323
Practice Address - Fax:817-282-6128
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23673103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4121566OtherAETNA PPO
TXB1379POtherBCBS
R69848Medicare UPIN