Provider Demographics
NPI:1780150276
Name:CAMARILLO CENTER FOR INDIVIDUAL AND FAMILY COUNSELING, INC.
Entity type:Organization
Organization Name:CAMARILLO CENTER FOR INDIVIDUAL AND FAMILY COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-625-3786
Mailing Address - Street 1:1601 CARMEN DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3103
Mailing Address - Country:US
Mailing Address - Phone:805-625-3786
Mailing Address - Fax:805-427-9047
Practice Address - Street 1:1601 CARMEN DR STE 102
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3103
Practice Address - Country:US
Practice Address - Phone:805-625-3786
Practice Address - Fax:805-427-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health