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General NPI Number Information
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NPI Number | 1417440884
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Entity Type | Individual
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Provider Name | DYLAN CAMACHO LPCC
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Gender | Male
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 06/21/2022
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Provider Practice Location Address
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Address Line | 1900 SMALLHOUSE RD
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City | BOWLING GREEN
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State | KY
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Zip | 42104-3270
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Country | US
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Telephone | 270-303-5292
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Fax | 270-596-0837
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Provider Business Mailing Address
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Address Line | 380 SUWANNEE TRAIL ST
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City | BOWLING GREEN
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State | KY
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Zip | 42103-7956
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Country | US
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Telephone | 270-901-5000
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Fax | 270-842-5268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 173714
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 263107
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License Number State | KY
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