Provider Demographics
NPI:1447669775
Name:FOSTER, CAMILLE CURTIS (LCSW)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:CURTIS
Last Name:FOSTER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:CURTIS
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:3325 N UNIVERSITY AVE
Mailing Address - Street 2:SUITE #275
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-4465
Mailing Address - Country:US
Mailing Address - Phone:801-472-7134
Mailing Address - Fax:
Practice Address - Street 1:3325 N UNIVERSITY AVE
Practice Address - Street 2:SUITE #275
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-4465
Practice Address - Country:US
Practice Address - Phone:801-472-7134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6225199-3501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health