Healthcare Provider Details

I. General information

NPI: 1033216346
Provider Name (Legal Business Name): WILLIAM M CAMP LSCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAIN ST
MEDFORD OR
97501-2756
US

IV. Provider business mailing address

300 W MAIN ST
MEDFORD OR
97501-2756
US

V. Phone/Fax

Practice location:
  • Phone: 541-772-1777
  • Fax: 541-734-2410
Mailing address:
  • Phone: 541-772-1777
  • Fax: 541-734-2410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2408
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: