Provider Demographics
NPI:1376243931
Name:ALLARD, CAMI REQUEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAMI
Middle Name:REQUEL
Last Name:ALLARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 STANDIFORD AVE STE E12
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-6525
Mailing Address - Country:US
Mailing Address - Phone:209-214-8259
Mailing Address - Fax:
Practice Address - Street 1:4116 SUMMERLIN CT
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8961
Practice Address - Country:US
Practice Address - Phone:209-214-8259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33453103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical