Provider Demographics
NPI:1558903765
Name:CAMP, CODI L (LMHP, LPC)
Entity Type:Individual
Prefix:
First Name:CODI
Middle Name:L
Last Name:CAMP
Suffix:
Gender:F
Credentials:LMHP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:WAHOO
Mailing Address - State:NE
Mailing Address - Zip Code:68066-2064
Mailing Address - Country:US
Mailing Address - Phone:402-413-0159
Mailing Address - Fax:
Practice Address - Street 1:134 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:WAHOO
Practice Address - State:NE
Practice Address - Zip Code:68066-2064
Practice Address - Country:US
Practice Address - Phone:402-413-0159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-09
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health