Provider Demographics
NPI:1356166821
Name:CAMP, HENRY ALEXANDER
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:ALEXANDER
Last Name:CAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 2ND AVE NW APT 309
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-2736
Mailing Address - Country:US
Mailing Address - Phone:580-798-7151
Mailing Address - Fax:
Practice Address - Street 1:307 4TH AVE SE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-8216
Practice Address - Country:US
Practice Address - Phone:580-319-5770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKBACB1226527103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst