Provider Demographics
NPI:1487461141
Name:LERMA, CELESTE HEIDY
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:HEIDY
Last Name:LERMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:HEIDY
Other - Last Name:SOTO-RENDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1061 SURREY CIR
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-5102
Mailing Address - Country:US
Mailing Address - Phone:817-902-5674
Mailing Address - Fax:
Practice Address - Street 1:505 WOODBRIDGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-7127
Practice Address - Country:US
Practice Address - Phone:817-902-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97304101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health