1154782563 NPI number — M.A. CAMP COUNSELING SERVICES, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154782563 NPI number — M.A. CAMP COUNSELING SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
M.A. CAMP COUNSELING SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154782563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2904 E STAN SCHLUETER LOOP # 38
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILLEEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76542-4813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-400-9931
Provider Business Mailing Address Fax Number:
866-873-4947

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W CENTRAL TEXAS EXPY STE 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARKER HEIGHTS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76548-7498
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-400-9931
Provider Business Practice Location Address Fax Number:
866-873-4947
Provider Enumeration Date:
03/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
CAMP
Authorized Official First Name:
MELANIEANN
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOTHERAPIST/OWNER
Authorized Official Telephone Number:
254-400-9931

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  11832 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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