Provider Demographics
NPI:1982994497
Name:COLPITTS, CAMILLE ELISA (AMFT)
Entity type:Individual
Prefix:MISS
First Name:CAMILLE
Middle Name:ELISA
Last Name:COLPITTS
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:CAMILLE
Other - Middle Name:ELISA
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AMFT
Mailing Address - Street 1:3855 N WEST AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-2759
Mailing Address - Country:US
Mailing Address - Phone:559-334-6433
Mailing Address - Fax:
Practice Address - Street 1:3855 N WEST AVE STE 110
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-2759
Practice Address - Country:US
Practice Address - Phone:559-334-6433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134960106H00000X
101YM0800X
CA94460101YM0800X, 106H00000X
CAIMF94460101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CVILLACREZOtherCCR