1376859033 NPI number — MRS. SHERLLEY YAMIRIE CAMPOS MS, LMHC, CAP

Table of content: MRS. SHERLLEY YAMIRIE CAMPOS MS, LMHC, CAP (NPI 1376859033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376859033 NPI number — MRS. SHERLLEY YAMIRIE CAMPOS MS, LMHC, CAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPOS
Provider First Name:
SHERLLEY
Provider Middle Name:
YAMIRIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LMHC, CAP
Provider Gender Code:
F

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:
1376859033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 423202
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34742-3202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-957-9077
Provider Business Mailing Address Fax Number:
888-702-0079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2311 N ORANGE BLOSSOM TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34744-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-957-9077
Provider Business Practice Location Address Fax Number:
888-702-0079
Provider Enumeration Date:
08/19/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MH 11107 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YA0400X , with the licence number: CAP2955 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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