MEDICARE: CAMI DOCCHIO MBE, ACMHC

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	101YM0800X	Mental Health Counselor	13977362-6009	UT

General Provider Information

NPI Number	:	1548091259
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMI DOCCHIO MBE, ACMHC

Provider Business Mailing Address
First Line	:	1104 N NOCTURNE DR
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84116-1735
Country	:	US
Telephone Number	:	484-792-1192
Fax Number	:

Provider Business Practice Location Address
First Line	:	4516 S 700 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-4192
Country	:	US
Telephone Number	:	385-293-1902
Fax Number	:

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

Provider Enumeration Date	:	08/13/2024
Last Update Date	:	08/13/2024

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