=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124799614
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERRIE E CAMPER PHD, LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2021
-----------------------------------------------------
Last Update Date | 09/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7225 N UNIVERSITY DR
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33321-2908
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-457-7391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5820 ERIK WAY
-----------------------------------------------------
City | GREENACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33463-5336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-457-7391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT2680
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------