Doctor Name: | MS. TONYA RENAE CAMACHO |
NPI Number: | 1922411354 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPCP |
License Number: | 180.007311 |
Business Practice Address: | 3205 W Kenwood Ave West Peoria, IL - 616044827 |
Business Phone Number: | 3096787030 |
Business Fax Number: | |
Mailing Address: | 3205 W Kenwood Ave, WEST PEORIA |
State: | IL |
Postal Code: | 616044827 |
Phone Number: | 3096787030 |
Fax Number: | |
NPI Enumeration Date: | 06/03/2014 |
NPI Last Update Date: | 06/03/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 180.007311 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |