Provider Demographics
NPI:1336260454
Name:SMITH, CAMILLE (MA, LPC, ATR-BC)
Entity Type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:MA, LPC, ATR-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 EAST BROADWAY ROAD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282
Mailing Address - Country:US
Mailing Address - Phone:602-373-3881
Mailing Address - Fax:
Practice Address - Street 1:2131 EAST BROADWAY ROAD
Practice Address - Street 2:SUITE 11
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:602-373-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC 1406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ735855OtherAHCCCS PROVIDER #