Provider Demographics
NPI:1912702564
Name:SMITH, CAMILLE MARY
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:MARY
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:MARY
Other - Last Name:URBAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:416 W 1360 N
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-1891
Mailing Address - Country:US
Mailing Address - Phone:801-771-0273
Mailing Address - Fax:801-771-0221
Practice Address - Street 1:935 E 2985 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040
Practice Address - Country:US
Practice Address - Phone:801-771-0273
Practice Address - Fax:801-771-0221
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician