Provider Demographics
NPI:1801136916
Name:PROULX, KAMELA MARIE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KAMELA
Middle Name:MARIE
Last Name:PROULX
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 S H ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6821
Mailing Address - Country:US
Mailing Address - Phone:805-979-9941
Mailing Address - Fax:805-222-3041
Practice Address - Street 1:126 S H ST
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6821
Practice Address - Country:US
Practice Address - Phone:805-979-9941
Practice Address - Fax:805-222-3041
Is Sole Proprietor?:No
Enumeration Date:2013-02-26
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13261103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst