Active NPI
Celice Korsten
- Clinical Psychologist
- Phoenix, AZ
National Provider Identifier
1235626565
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4208
- Practice address
- 11020 N. Tatum Blvd., Ste. 100
Phoenix, AZ 85028 - Phone
- (480) 678-4193
- NPI assigned
- Apr 23, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Forensic Psychologist | 103TF0200X | 4208 | AZ | |
| Clinical Psychologist | 103TC0700X | 4208 | AZ | Primary |
Addresses
Primary practice location
11020 N. Tatum Blvd., Ste. 100
Phoenix, AZ 85028
Mailing address
11020 N. Tatum Blvd. Ste. 100
Phoenix, AZ 85028
Phone (480) 678-4193
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4208 | AZ | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524441600000",
"number": "1235626565",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11020 N. TATUM BLVD. STE. 100",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "85028",
"telephone_number": "480-678-4193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11020 N. TATUM BLVD., STE. 100",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "85028",
"telephone_number": "480-678-4193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KORSTEN",
"first_name": "CELICE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-23",
"last_updated": "2018-04-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "AZ",
"license": "4208",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "AZ",
"license": "4208",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.