Healthcare Provider Details

I. General information

NPI: 1992384416
Provider Name (Legal Business Name): CELES SMITH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 CAMPBELL LN STE 109
BOWLING GREEN KY
42104-1062
US

IV. Provider business mailing address

891 HIGDON RD
CLARKSON KY
42726-7143
US

V. Phone/Fax

Practice location:
  • Phone: 855-387-4378
  • Fax:
Mailing address:
  • Phone: 502-296-9523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255556
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: