Provider Demographics
NPI:1336488865
Name:MCGILLIS, CAMILLE (LCMHC)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:MCGILLIS
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:H
Other - Last Name:DOWNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC
Mailing Address - Street 1:2825 E COTTONWOOD PKWY STE 550
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7080
Mailing Address - Country:US
Mailing Address - Phone:801-916-0831
Mailing Address - Fax:
Practice Address - Street 1:2825 E COTTONWOOD PKWY STE 550
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-7080
Practice Address - Country:US
Practice Address - Phone:801-916-0831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-04
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT101YM0800X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health