Provider Demographics
NPI:1851564371
Name:CAMGEN INC
Entity Type:Organization
Organization Name:CAMGEN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SKLUZACEK
Authorized Official - Suffix:
Authorized Official - Credentials:MS LMHC
Authorized Official - Phone:727-244-6536
Mailing Address - Street 1:2828 SKIMMER POINT DR S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3942
Mailing Address - Country:US
Mailing Address - Phone:727-244-6536
Mailing Address - Fax:
Practice Address - Street 1:111 2ND AVE NE
Practice Address - Street 2:SUITE 511
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3434
Practice Address - Country:US
Practice Address - Phone:727-244-6536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5958101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty