Provider Demographics
NPI:1346810215
Name:CELUCH, AMETHYST CLARE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMETHYST
Middle Name:CLARE
Last Name:CELUCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 JACKS RUN RD STE 201-203
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2538
Mailing Address - Country:US
Mailing Address - Phone:724-600-5541
Mailing Address - Fax:412-872-5456
Practice Address - Street 1:3001 JACKS RUN RD STE 201-203
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2538
Practice Address - Country:US
Practice Address - Phone:724-600-5541
Practice Address - Fax:412-872-5456
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
PACW0246021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker