Basic Information
| Provider Information | |||||||||
| NPI: | 1720615586 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CAMELOT BEHAVIORAL HEALTH CLINIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3800 N MESA | ||||||||
| Address2: | SUITE A2, #201 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799021512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9153837354 | ||||||||
| FaxNumber: | 9152755521 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 DENVER AVE | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799023008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155444000 | ||||||||
| FaxNumber: | 9152199022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/23/2020 | ||||||||
| LastUpdateDate: | 05/13/2020 | ||||||||
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| AuthorizedOfficialLastName: | MOLINA | ||||||||
| AuthorizedOfficialFirstName: | ALFREDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9152744188 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | DNP-PMHNP-BC | ||||||||
| NPICertificationDate: | 05/13/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.