Provider Demographics
NPI:1154076487
Name:CANALES, CAMILLE (LMFT)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:CANALES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3128 REDONDO CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-5397
Mailing Address - Country:US
Mailing Address - Phone:530-338-1229
Mailing Address - Fax:
Practice Address - Street 1:2030 HARTNELL AVE STE D
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-5070
Practice Address - Country:US
Practice Address - Phone:530-338-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA144498101YM0800X
CA124986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health