Healthcare Provider Details

I. General information

NPI: 1265299028
Provider Name (Legal Business Name): CAMI IMPERATO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1312 N MERIDIAN RD
KALISPELL MT
59901-3095
US

IV. Provider business mailing address

1312 N MERIDIAN RD
KALISPELL MT
59901-3095
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-6453
  • Fax: 406-756-8546
Mailing address:
  • Phone: 406-756-6453
  • Fax: 406-756-8546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberBBH-LAC-LIC-70262
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: