MEDICARE: MISS CAMILLE ELISA COLPITTS AMFT

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	106H00000X	Marriage & Family Therapist	134960	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CVILLACREZ	OTHER		CCR

General Provider Information

NPI Number	:	1982994497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CAMILLE ELISA COLPITTS AMFT

Provider Business Mailing Address
First Line	:	3855 N WEST AVE STE 110
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-2759
Country	:	US
Telephone Number	:	559-334-6433
Fax Number	:

Provider Business Practice Location Address
First Line	:	3855 N WEST AVE STE 110
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93705-2759
Country	:	US
Telephone Number	:	559-334-6433
Fax Number	:

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

Provider Enumeration Date	:	04/18/2011
Last Update Date	:	10/18/2024

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