Provider Demographics
NPI:1316652258
Name:HUERTA, CELINA (MA, LCPC, CSTIP)
Entity type:Individual
Prefix:
First Name:CELINA
Middle Name:
Last Name:HUERTA
Suffix:
Gender:F
Credentials:MA, LCPC, CSTIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 N LAWLER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60651-1566
Mailing Address - Country:US
Mailing Address - Phone:872-237-1367
Mailing Address - Fax:
Practice Address - Street 1:1700 W IRVING PARK RD STE 104
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2596
Practice Address - Country:US
Practice Address - Phone:872-228-6416
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.015726101Y00000X
IL178018711101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor