Provider Demographics
NPI:1619511581
Name:COFFEY, CAMILLE MARI (LPC)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:MARI
Last Name:COFFEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 SCARBOUROUGH
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:TX
Mailing Address - Zip Code:78133-4529
Mailing Address - Country:US
Mailing Address - Phone:830-964-4390
Mailing Address - Fax:
Practice Address - Street 1:650 SCARBOUROUGH
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:TX
Practice Address - Zip Code:78133-4529
Practice Address - Country:US
Practice Address - Phone:830-964-4390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health