Provider Demographics
NPI:1578013488
Name:HINCKLE, CAMRON (MS, LPC-IT)
Entity Type:Individual
Prefix:
First Name:CAMRON
Middle Name:
Last Name:HINCKLE
Suffix:
Gender:M
Credentials:MS, LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12630 W NORTH AVE
Mailing Address - Street 2:BUILDING E
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4626
Mailing Address - Country:US
Mailing Address - Phone:262-785-1008
Mailing Address - Fax:262-432-9259
Practice Address - Street 1:12630 W NORTH AVE
Practice Address - Street 2:BUILDING E
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4626
Practice Address - Country:US
Practice Address - Phone:262-785-1008
Practice Address - Fax:262-432-9259
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2829-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health