Basic Information
| Provider Information | |||||||||
| NPI: | 1477827145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CELESTIN | ||||||||
| FirstName: | LATOYA | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1340 W TUNNEL BLVD STE 430 | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703602829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858538550 | ||||||||
| FaxNumber: | 9858538559 | ||||||||
| Practice Location | |||||||||
| Address1: | 235 CIVIC CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703605937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9853332020 | ||||||||
| FaxNumber: | 9858510162 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2012 | ||||||||
| LastUpdateDate: | 05/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 1041C0700X | 12468 | LA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.