MEDICARE: MRS. CAMILLE RENE SEARS LCPC

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	101YM0800X	Mental Health Counselor	180.011513	IL

General Provider Information

NPI Number	:	1578960373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAMILLE RENE SEARS LCPC

Provider Business Mailing Address
First Line	:	7521 S OLYMPIA AVE # 1100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-1855
Country	:	US
Telephone Number	:	918-200-2894
Fax Number	:

Provider Business Practice Location Address
First Line	:	7521 S OLYMPIA AVE # 1100
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74132-1855
Country	:	US
Telephone Number	:	918-200-2894
Fax Number	:

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

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	03/06/2023

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