Healthcare Provider Details

I. General information

NPI: 1205558079
Provider Name (Legal Business Name): CAMILLE FIRTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 TAYLOR ST NE
SALEM OR
97301-8340
US

IV. Provider business mailing address

375 TAYLOR ST NE
SALEM OR
97301-8340
US

V. Phone/Fax

Practice location:
  • Phone: 503-689-1006
  • Fax:
Mailing address:
  • Phone: 503-689-1006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR12336
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: