Provider Demographics
NPI:1790219228
Name:UTHE-BUROW, CELESTE MICHELE
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:MICHELE
Last Name:UTHE-BUROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 E 41ST ST
Mailing Address - Street 2:100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-6053
Mailing Address - Country:US
Mailing Address - Phone:605-444-7643
Mailing Address - Fax:605-444-7690
Practice Address - Street 1:705 E 41ST ST
Practice Address - Street 2:100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-6053
Practice Address - Country:US
Practice Address - Phone:605-444-7643
Practice Address - Fax:605-444-7690
Is Sole Proprietor?:No
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1170101Y00000X
SD710101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor