Provider Demographics
NPI:1194369470
Name:CAMOU, MARCELENE (LPCC)
Entity Type:Individual
Prefix:
First Name:MARCELENE
Middle Name:
Last Name:CAMOU
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:SHOW LOW
Mailing Address - State:AZ
Mailing Address - Zip Code:85901-8325
Mailing Address - Country:US
Mailing Address - Phone:661-433-4183
Mailing Address - Fax:
Practice Address - Street 1:1100 E DEUCE OF CLUBS STE D
Practice Address - Street 2:
Practice Address - City:SHOW LOW
Practice Address - State:AZ
Practice Address - Zip Code:85901-4943
Practice Address - Country:US
Practice Address - Phone:661-433-4183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5978101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health