Provider Demographics
NPI:1639476344
Name:LA MER, CAMILLA
Entity type:Individual
Prefix:
First Name:CAMILLA
Middle Name:
Last Name:LA MER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19845
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-2845
Mailing Address - Country:US
Mailing Address - Phone:303-746-1890
Mailing Address - Fax:
Practice Address - Street 1:2735 IRIS AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-2436
Practice Address - Country:US
Practice Address - Phone:303-746-1890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0012690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional