MEDICARE: CAMILLE MERCEDES MCCORMICK LPC

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	101YP2500X	Professional Counselor	LPC-16529	AZ

General Provider Information

NPI Number	:	1679014476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE MERCEDES MCCORMICK LPC

Provider Business Mailing Address
First Line	:	7600 N 15TH ST STE 150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4305
Country	:	US
Telephone Number	:	480-256-8240
Fax Number	:	480-428-8817

Provider Business Practice Location Address
First Line	:	7600 N 15TH ST STE 150
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-4305
Country	:	US
Telephone Number	:	480-256-8240
Fax Number	:	480-428-8817

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

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	02/26/2025

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