Provider Demographics
NPI:1922438266
Name:MCGINNIS, CELESE RENADA (MS, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:CELESE
Middle Name:RENADA
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:CELESE
Other - Middle Name:
Other - Last Name:SULTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, BCBA, COBA LBA
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:175 MARKET PLACE DR STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-4471
Practice Address - Country:US
Practice Address - Phone:502-251-7002
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2013-11-23
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-16-22662103K00000X
KY173224103K00000X, 103K00000X
103K00000X
OHCOBA.341103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-16-22662OtherBCBA CERTIFICATE