Provider Demographics
NPI:1295365278
Name:GUSME, CELESTE (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:
Last Name:GUSME
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 VIEJITA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1841
Mailing Address - Country:US
Mailing Address - Phone:210-374-4207
Mailing Address - Fax:
Practice Address - Street 1:12702 TOEPPERWEIN RD STE 236
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3231
Practice Address - Country:US
Practice Address - Phone:210-286-9339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2020-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77463101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health