Provider Demographics
NPI:1184241234
Name:CAMACHO GARCIA, JOSEPHINA (MA)
Entity type:Individual
Prefix:MS
First Name:JOSEPHINA
Middle Name:
Last Name:CAMACHO GARCIA
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 1:3077 S 47TH DR
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-7433
Mailing Address - Country:US
Mailing Address - Phone:928-581-4911
Mailing Address - Fax:
Practice Address - Street 1:281 W 24TH ST # 139
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8500
Practice Address - Country:US
Practice Address - Phone:928-581-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-05
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAMFT-10476106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist