Healthcare Provider Details

I. General information

NPI: 1972479319
Provider Name (Legal Business Name): CELEST LARSON MSW, LCSW, LAC, QMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2412 S CLIFF AVE
SIOUX FALLS SD
57105-4031
US

IV. Provider business mailing address

2412 S CLIFF AVE
SIOUX FALLS SD
57105-4031
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-4079
  • Fax:
Mailing address:
  • Phone: 605-322-4079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25032042
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6661
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: