Provider Demographics
NPI:1730766171
Name:CELIS, GISSELLE
Entity type:Individual
Prefix:
First Name:GISSELLE
Middle Name:
Last Name:CELIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1080 S LA CIENEGA BLVD, SUITE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035
Mailing Address - Country:US
Mailing Address - Phone:619-550-6368
Mailing Address - Fax:
Practice Address - Street 1:1601 NEW STINE RD, SUITE 195
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309
Practice Address - Country:US
Practice Address - Phone:323-505-6985
Practice Address - Fax:323-714-0112
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BACB693193101YM0800X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician