Provider Demographics
NPI:1689050221
Name:HARDMAN, CAMILLE (LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:HARDMAN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1904 JENNIE LEE DR
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-6159
Mailing Address - Country:US
Mailing Address - Phone:208-523-1558
Mailing Address - Fax:
Practice Address - Street 1:1904 JENNIE LEE DR
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-6159
Practice Address - Country:US
Practice Address - Phone:208-523-1558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-5943101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDLPC-5943OtherSTATE COUNSELING LICENSE