Individual
CELESTIA LUELLA CLARK I
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
249 S 100 E STREET, ENTERPRISE, UT 84725-7648
(435) 231-3657
Mailing address
PO BOX 86, ENTERPRISE, UT 84725-0086
(435) 231-3657
(907) 262-9290
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
1041C0700X
Clinical Social Worker
10628149-3501
UT
1041C0700X
Clinical Social Worker
159355
AK
Other
Enumeration date
06/28/2019
Last updated
08/13/2025
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