Provider Demographics
NPI:1780391649
Name:CAMP, BARRY WAYNE (LPC)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:WAYNE
Last Name:CAMP
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21991 AL HIGHWAY 117
Mailing Address - Street 2:
Mailing Address - City:IDER
Mailing Address - State:AL
Mailing Address - Zip Code:35981-4207
Mailing Address - Country:US
Mailing Address - Phone:256-687-9517
Mailing Address - Fax:
Practice Address - Street 1:215 GRAND AVE SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35967-1917
Practice Address - Country:US
Practice Address - Phone:256-279-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-31
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC05401101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor