Provider Demographics
NPI:1558896829
Name:PHILLIPS, CAMILLE ANNE
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:ANNE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 RIO DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-2922
Mailing Address - Country:US
Mailing Address - Phone:727-858-6582
Mailing Address - Fax:
Practice Address - Street 1:5951 RIO DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2922
Practice Address - Country:US
Practice Address - Phone:727-858-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-25
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician