Provider Demographics
NPI:1902541543
Name:CAMOMILE, KRISTINE C (LCMHC)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:C
Last Name:CAMOMILE
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3995 W CORN PATCH AVE
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-4449
Mailing Address - Country:US
Mailing Address - Phone:801-834-1790
Mailing Address - Fax:
Practice Address - Street 1:3995 W CORN PATCH AVE
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-4449
Practice Address - Country:US
Practice Address - Phone:801-834-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-28
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8442892-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty