Provider Demographics
NPI:1013135524
Name:USERA, CHRISTLE CELESTE (MSW/CSW-PIP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTLE
Middle Name:CELESTE
Last Name:USERA
Suffix:
Gender:F
Credentials:MSW/CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MENTAL HEALTH CLINIC
Mailing Address - Street 2:2900 DOOLITTLE DRIVE
Mailing Address - City:ELLSWORTH AFB
Mailing Address - State:SD
Mailing Address - Zip Code:57706
Mailing Address - Country:US
Mailing Address - Phone:605-385-3656
Mailing Address - Fax:605-385-2030
Practice Address - Street 1:2900 DOOLITTLE DR
Practice Address - Street 2:
Practice Address - City:ELLSWORTH AFB
Practice Address - State:SD
Practice Address - Zip Code:57706-4821
Practice Address - Country:US
Practice Address - Phone:605-385-3656
Practice Address - Fax:605-385-2030
Is Sole Proprietor?:No
Enumeration Date:2007-04-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD23111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2311OtherLICENSE