Provider Demographics
NPI:1679969034
Name:STEPHANIE CAMACHO, MA, LPC, LLC
Entity Type:Organization
Organization Name:STEPHANIE CAMACHO, MA, LPC, LLC
Other - Org Name:STEPHANIE CAMACHO, LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMACHO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-974-1224
Mailing Address - Street 1:4404 N LIBBY AVE
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73122-4405
Mailing Address - Country:US
Mailing Address - Phone:405-974-1224
Mailing Address - Fax:405-979-8328
Practice Address - Street 1:2529 S KELLY AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2966
Practice Address - Country:US
Practice Address - Phone:405-974-1224
Practice Address - Fax:405-979-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5671101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty