Provider Demographics
NPI:1235597121
Name:CAMP, LEONARD
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:
Last Name:CAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3397 E DERRINGER WAY
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-7777
Mailing Address - Country:US
Mailing Address - Phone:602-578-7132
Mailing Address - Fax:
Practice Address - Street 1:17242 S HEALTHCARE DR
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-8501
Practice Address - Country:US
Practice Address - Phone:520-796-3815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC 10985101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)