Provider Demographics
NPI:1033326301
Name:CAMAS PROFESSIONAL COUNSELING
Entity Type:Organization
Organization Name:CAMAS PROFESSIONAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-983-0235
Mailing Address - Street 1:304 N STATE ST
Mailing Address - Street 2:PO BOX 627
Mailing Address - City:GRANGEVILLE
Mailing Address - State:ID
Mailing Address - Zip Code:83530-1769
Mailing Address - Country:US
Mailing Address - Phone:208-983-0235
Mailing Address - Fax:208-983-0245
Practice Address - Street 1:304 N STATE ST
Practice Address - Street 2:
Practice Address - City:GRANGEVILLE
Practice Address - State:ID
Practice Address - Zip Code:83530-1769
Practice Address - Country:US
Practice Address - Phone:208-983-0235
Practice Address - Fax:208-983-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807098900Medicaid
ID807099000Medicaid
ID807068800Medicaid
ID807353600Medicaid
ID807068700Medicaid