Healthcare Provider Details

I. General information

NPI: 1831595206
Provider Name (Legal Business Name): JESSICA RAENA CAMANO LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 E FAIRMOUNT AVE
PHOENIX AZ
85016-6906
US

IV. Provider business mailing address

16251 N CAVE CREEK RD
PHOENIX AZ
85032-2976
US

V. Phone/Fax

Practice location:
  • Phone: 602-808-2816
  • Fax: 602-808-2716
Mailing address:
  • Phone: 480-882-4545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20850
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: