Basic Information
| Provider Information | |||||||||
| NPI: | 1003156829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CELIO | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.F.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 N HARBOR BLVD | ||||||||
| Address2: | 202 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928321990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147213991 | ||||||||
| FaxNumber: | 7145250834 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 N HARBOR BLVD | ||||||||
| Address2: | 202 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928321990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147213991 | ||||||||
| FaxNumber: | 7145250834 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2013 | ||||||||
| LastUpdateDate: | 02/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC45101 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.