Healthcare Provider Details

I. General information

NPI: 1659545598
Provider Name (Legal Business Name): DESSIE REE CAMMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 LONG BEACH BLVD
LONG BEACH CA
90807-4013
US

IV. Provider business mailing address

901 W CHERRY ST
COMPTON CA
90222-3803
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-2006
  • Fax:
Mailing address:
  • Phone: 310-632-4909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: