Doctor Name: | MR. LEONARD CAMP |
NPI Number: | 1235597121 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | LISAC 10985 |
Business Practice Address: | 17242 S Healthcare Dr Laveen, AZ - 853398501 |
Business Phone Number: | 5207963815 |
Business Fax Number: | |
Mailing Address: | 3397 E Derringer Way, GILBERT |
State: | AZ |
Postal Code: | 852977777 |
Phone Number: | 6025787132 |
Fax Number: | |
NPI Enumeration Date: | 02/05/2016 |
NPI Last Update Date: | 02/05/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | LISAC 10985 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AZ |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |