Provider Demographics
NPI:1114380904
Name:MCCAMLEY, GAYLE PATRICE (CP00001641)
Entity Type:Individual
Prefix:MS
First Name:GAYLE
Middle Name:PATRICE
Last Name:MCCAMLEY
Suffix:
Gender:F
Credentials:CP00001641
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9105 NE HIGHWAY 99
Mailing Address - Street 2:SUITE B
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98665-8961
Mailing Address - Country:US
Mailing Address - Phone:360-571-4359
Mailing Address - Fax:360-576-6900
Practice Address - Street 1:9105 NE HIGHWAY 99
Practice Address - Street 2:SUITE B
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8961
Practice Address - Country:US
Practice Address - Phone:360-571-4359
Practice Address - Fax:360-576-6900
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00001641101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)