Provider Demographics
NPI:1477147569
Name:DECAMILLIS, ALLISON (LPCC, ATR)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:DECAMILLIS
Suffix:
Gender:F
Credentials:LPCC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 HAZELTINE BOULEVARD
Mailing Address - Street 2:SUITE 496, MD 45
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-1000
Mailing Address - Country:US
Mailing Address - Phone:952-240-3334
Mailing Address - Fax:
Practice Address - Street 1:1107 HAZELTINE BOULEVARD
Practice Address - Street 2:SUITE 496, MD 45
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1000
Practice Address - Country:US
Practice Address - Phone:952-240-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-01
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01514101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health