MEDICARE: CAMILLE HOLDERMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1205335981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE HOLDERMAN

Provider Business Mailing Address
First Line	:	1485 SANDSTONE
Second Line	:
City	:	MCKINLEYVILLE
State	:	CA
Zip	:	95519-4724
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 O ST STE C
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-5789
Country	:	US
Telephone Number	:	707-826-0872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2018
Last Update Date	:	02/07/2018

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Directions to “ CAMILLE HOLDERMAN ” Practice Location

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