Provider Demographics
NPI:1922411354
Name:CAMACHO, TONYA RENAE (LPCP)
Entity Type:Individual
Prefix:MS
First Name:TONYA
Middle Name:RENAE
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:LPCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3205 W KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61604-4827
Mailing Address - Country:US
Mailing Address - Phone:309-678-7030
Mailing Address - Fax:
Practice Address - Street 1:3205 W KENWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61604-4827
Practice Address - Country:US
Practice Address - Phone:309-678-7030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007311101Y00000X, 101YA0400X
180.007311101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional