Provider Demographics
NPI:1144396425
Name:WALLER, CELESTE M (PSY D)
Entity Type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:M
Last Name:WALLER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-2621
Mailing Address - Country:US
Mailing Address - Phone:513-948-3721
Mailing Address - Fax:513-948-8631
Practice Address - Street 1:1101 SUMMIT RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-2621
Practice Address - Country:US
Practice Address - Phone:513-948-3721
Practice Address - Fax:513-948-8631
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6042103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical