Provider Demographics
NPI:1932284064
Name:CAMP, WILLIAM LYMAN JR (PHD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LYMAN
Last Name:CAMP
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:923 EDWIN ST
Mailing Address - Street 2:
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-4046
Mailing Address - Country:US
Mailing Address - Phone:715-735-5550
Mailing Address - Fax:715-735-0207
Practice Address - Street 1:923 EDWIN ST
Practice Address - Street 2:
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-4046
Practice Address - Country:US
Practice Address - Phone:715-735-5550
Practice Address - Fax:715-735-0207
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI09103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39059600Medicaid
WI84941Medicare ID - Type Unspecified
WIR56467Medicare UPIN