Healthcare Provider Details

I. General information

NPI: 1366744005
Provider Name (Legal Business Name): CAMILLE WEBB LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 02/14/2026
Certification Date: 02/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

186 E 1800 N
NORTH LOGAN UT
84341-2019
US

IV. Provider business mailing address

186 E 1800 N
NORTH LOGAN UT
84341-2019
US

V. Phone/Fax

Practice location:
  • Phone: 435-213-3062
  • Fax:
Mailing address:
  • Phone: 435-213-3062
  • Fax: 435-752-1095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5704514-3501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: