Provider Demographics
NPI:1770022535
Name:WEAS, CAMILLE FAYE (MA)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:FAYE
Last Name:WEAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 W 31ST ST APT 304
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5326
Mailing Address - Country:US
Mailing Address - Phone:612-790-5767
Mailing Address - Fax:763-205-3702
Practice Address - Street 1:8085 WAYZATA BLVD STE 212
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1457
Practice Address - Country:US
Practice Address - Phone:612-790-5767
Practice Address - Fax:763-205-3702
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1817101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty