Provider Demographics
NPI:1265028641
Name:THOMPSON, CAMILLE TERESA (SUDC COUNSELLING INT)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:TERESA
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:SUDC COUNSELLING INT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3868 W PARACHUTE DR
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-5782
Mailing Address - Country:US
Mailing Address - Phone:385-343-9407
Mailing Address - Fax:
Practice Address - Street 1:3269 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-3773
Practice Address - Country:US
Practice Address - Phone:801-935-4447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician