MEDICARE: HEATHER MARIE CAMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	C.1800789-TRNE	OH

General Provider Information

NPI Number	:	1265921159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER MARIE CAMP

Provider Business Mailing Address
First Line	:	240 N OAKLAND AVE
Second Line	:
City	:	WASHINGTON COURT HOUSE
State	:	OH
Zip	:	43160-1234
Country	:	US
Telephone Number	:	740-253-8382
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 N OAKLAND AVE
Second Line	:
City	:	WASHINGTON COURT HOUSE
State	:	OH
Zip	:	43160-1234
Country	:	US
Telephone Number	:	740-335-6935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2018
Last Update Date	:	05/07/2018

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Directions to “ HEATHER MARIE CAMP ” Practice Location

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