Provider Demographics
NPI:1497346985
Name:CAMP FAMILY LLC
Entity Type:Organization
Organization Name:CAMP FAMILY LLC
Other - Org Name:FAMILY FORWARD ABA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMP
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:206-799-2467
Mailing Address - Street 1:225 MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2550
Mailing Address - Country:US
Mailing Address - Phone:850-781-0406
Mailing Address - Fax:850-378-5233
Practice Address - Street 1:225 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541
Practice Address - Country:US
Practice Address - Phone:850-781-0406
Practice Address - Fax:850-378-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty