Provider Demographics
NPI:1366875601
Name:ANDERSON, CAMILLE ELISA (LPC)
Entity type:Individual
Prefix:MISS
First Name:CAMILLE
Middle Name:ELISA
Last Name:ANDERSON
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 1:4856 NE PRESCOTT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1751
Mailing Address - Country:US
Mailing Address - Phone:662-321-1448
Mailing Address - Fax:
Practice Address - Street 1:4856 NE PRESCOTT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1751
Practice Address - Country:US
Practice Address - Phone:662-321-1448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14862101Y00000X
101YM0800X
TN8008101Y00000X
ORC8053101YP2500X, 101Y00000X
FLTPMC4949101Y00000X
MS2162101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health