Provider Demographics
NPI:1679346167
Name:BURT, CELESTE
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:BURT
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 1:15326 DELACHAISE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-882-7579
Mailing Address - Fax:
Practice Address - Street 1:32600 HWY 281 N
Practice Address - Street 2:STE 1101
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163
Practice Address - Country:US
Practice Address - Phone:830-624-6846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85729101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional