Provider Demographics
NPI:1164262655
Name:ANDERSON, CAMILLE (ACMHC)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:ACMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 W 1460 N
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-2366
Mailing Address - Country:US
Mailing Address - Phone:801-602-3147
Mailing Address - Fax:
Practice Address - Street 1:532 E 800 N BLDG 2
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84097-4146
Practice Address - Country:US
Practice Address - Phone:385-230-7998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-31
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14001150-6009101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health