Provider Demographics
NPI:1316647779
Name:BECK, CAMILLE RENEE (LPC MHSP)
Entity type:Individual
Prefix:MRS
First Name:CAMILLE
Middle Name:RENEE
Last Name:BECK
Suffix:
Gender:F
Credentials:LPC MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9698 MULBERRY GAP WAY
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-1453
Mailing Address - Country:US
Mailing Address - Phone:423-362-0309
Mailing Address - Fax:
Practice Address - Street 1:6160 SHALLOWFORD RD STE 103
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7213
Practice Address - Country:US
Practice Address - Phone:423-933-1224
Practice Address - Fax:423-892-6182
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4876101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1992853352OtherADDICTION