Provider Demographics
NPI:1346913795
Name:MCCORMACK, CAMILLE ZEBELMAN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:ZEBELMAN
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3322 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-2614
Mailing Address - Country:US
Mailing Address - Phone:314-265-1171
Mailing Address - Fax:
Practice Address - Street 1:3322 S 9TH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-2614
Practice Address - Country:US
Practice Address - Phone:314-265-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015029575101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional