Healthcare Provider Details

I. General information

NPI: 1043675838
Provider Name (Legal Business Name): CLARISSE KAMGAING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2442 E ELEANA LN
GILBERT AZ
85298-2314
US

IV. Provider business mailing address

2184 E FIRESTONE DR
CHANDLER AZ
85249-4634
US

V. Phone/Fax

Practice location:
  • Phone: 480-247-9993
  • Fax: 480-719-8105
Mailing address:
  • Phone: 602-400-7764
  • Fax: 480-719-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License NumberBH-4784
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: