1861814246 NPI number — KELLIE GIORGIO CAMELFORD MS, LPC, NCC

Table of content: KELLIE GIORGIO CAMELFORD MS, LPC, NCC (NPI 1861814246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861814246 NPI number — KELLIE GIORGIO CAMELFORD MS, LPC, NCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMELFORD
Provider First Name:
KELLIE
Provider Middle Name:
GIORGIO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC, NCC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIORGIO
Provider Other First Name:
KELLIE
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1861814246
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6660 RIVERSIDE DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
METAIRIE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70003-3272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-908-0017
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6660 RIVERSIDE DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70003-3272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-908-0017
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2014

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: 101YP2500X , with the licence number:  4701 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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