Provider Demographics
NPI:1376859033
Name:CAMPOS, SHERLLEY YAMIRIE (MS, LMHC, CAP)
Entity Type:Individual
Prefix:MRS
First Name:SHERLLEY
Middle Name:YAMIRIE
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:MS, LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 423202
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-3202
Mailing Address - Country:US
Mailing Address - Phone:407-957-9077
Mailing Address - Fax:888-702-0079
Practice Address - Street 1:2311 N ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-2313
Practice Address - Country:US
Practice Address - Phone:407-957-9077
Practice Address - Fax:888-702-0079
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-19
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11107101YM0800X
FLCAP2955101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)