Provider Demographics
NPI:1174384911
Name:VAN HOUTEN, CELESTE MARLAINA (LMT)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:MARLAINA
Last Name:VAN HOUTEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4970 SW ROSSI TER
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2018
Mailing Address - Country:US
Mailing Address - Phone:707-364-9387
Mailing Address - Fax:
Practice Address - Street 1:21370 SW LANGER FARMS PKWY STE 138
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9140
Practice Address - Country:US
Practice Address - Phone:503-386-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR28100225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist