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General NPI Number Information
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NPI Number | 1679969034
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Entity Type | Organization
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Legal Business Name | STEPHANIE CAMACHO, MA, LPC, LLC
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Dates
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Enumeration Date | 04/13/2015
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Last Update Date | 04/13/2015
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Provider Practice Location Address
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Address Line | 2529 S KELLY AVE SUITE C
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City | EDMOND
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State | OK
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Zip | 73013-2966
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Country | US
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Telephone | 405-974-1224
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Fax | 405-979-8328
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Provider Business Mailing Address
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Address Line | 4404 N LIBBY AVE
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City | WARR ACRES
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State | OK
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Zip | 73122-4405
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Country | US
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Telephone | 405-974-1224
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Fax | 405-979-8328
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | STEPHANIE CAMACHO
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Credential | LPC
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Telephone | 405-974-1224
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 5671
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License Number State | OK
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