Provider Demographics
NPI:1891358032
Name:CELESTINO, BRYNN (CSW)
Entity Type:Individual
Prefix:
First Name:BRYNN
Middle Name:
Last Name:CELESTINO
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 S 800 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4055
Mailing Address - Country:US
Mailing Address - Phone:435-849-6189
Mailing Address - Fax:801-669-5889
Practice Address - Street 1:1530 S 500 W
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-6014
Practice Address - Country:US
Practice Address - Phone:801-669-5861
Practice Address - Fax:801-669-5889
Is Sole Proprietor?:No
Enumeration Date:2019-04-14
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11770884-35021041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program