Provider Demographics
NPI:1326860230
Name:RUCKER, CAMILLE (LPC)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12305 BRISTOL AVE
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-1827
Mailing Address - Country:US
Mailing Address - Phone:816-877-6420
Mailing Address - Fax:
Practice Address - Street 1:4701 COLLEGE BLVD STE 115
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1608
Practice Address - Country:US
Practice Address - Phone:816-877-6420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLPC04764101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health