Provider Demographics
NPI:1699960278
Name:DAIBER, CELESTE R (MED, LPC, NCC, RPT)
Entity type:Individual
Prefix:MS
First Name:CELESTE
Middle Name:R
Last Name:DAIBER
Suffix:
Gender:F
Credentials:MED, LPC, NCC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2824
Mailing Address - Country:US
Mailing Address - Phone:636-724-1224
Mailing Address - Fax:636-724-1226
Practice Address - Street 1:408 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2824
Practice Address - Country:US
Practice Address - Phone:636-724-1224
Practice Address - Fax:636-724-1226
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007008532101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO494049109Medicaid