Provider Demographics
NPI:1720615586
Name:CAMELOT BEHAVIORAL HEALTH CLINIC, PLLC
Entity Type:Organization
Organization Name:CAMELOT BEHAVIORAL HEALTH CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DNP-PMHNP-BC
Authorized Official - Phone:915-274-4188
Mailing Address - Street 1:3800 N MESA
Mailing Address - Street 2:SUITE A2, #201
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1512
Mailing Address - Country:US
Mailing Address - Phone:915-383-7354
Mailing Address - Fax:915-275-5521
Practice Address - Street 1:1900 DENVER AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3008
Practice Address - Country:US
Practice Address - Phone:915-544-4000
Practice Address - Fax:915-219-9022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty