Healthcare Provider Details

I. General information

NPI: 1720300106
Provider Name (Legal Business Name): YOLANDA ALICIA CAMACHO LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 ANGELINA BLVD
CHAPARRAL NM
88081-7558
US

IV. Provider business mailing address

5208 CORNELL AVE
EL PASO TX
79924-5334
US

V. Phone/Fax

Practice location:
  • Phone: 575-824-8100
  • Fax: 575-824-8101
Mailing address:
  • Phone: 915-356-0741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0219491
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64023
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: