Provider Demographics
NPI:1669764122
Name:CAMILLUS, COURTNEY MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MARIE
Last Name:CAMILLUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 POLARIS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2108
Mailing Address - Country:US
Mailing Address - Phone:614-430-9837
Mailing Address - Fax:614-430-9697
Practice Address - Street 1:2000 POLARIS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2108
Practice Address - Country:US
Practice Address - Phone:614-430-9837
Practice Address - Fax:614-430-9697
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6686103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist