Provider Demographics
NPI:1497387104
Name:CAMELOT COMMUNITY CARE
Entity Type:Organization
Organization Name:CAMELOT COMMUNITY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:SR
Authorized Official - Credentials:DR
Authorized Official - Phone:832-253-8273
Mailing Address - Street 1:1601 NE 25TH AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-4885
Mailing Address - Country:US
Mailing Address - Phone:352-671-7884
Mailing Address - Fax:
Practice Address - Street 1:1601 NE 25TH AVE STE 306
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4885
Practice Address - Country:US
Practice Address - Phone:352-671-7884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty