Provider Demographics
NPI:1144265653
Name:POUSSON, CAMILLE MARIA (MD)
Entity type:Individual
Prefix:MS
First Name:CAMILLE
Middle Name:MARIA
Last Name:POUSSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SOUTH 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501
Mailing Address - Country:US
Mailing Address - Phone:254-298-7000
Mailing Address - Fax:254-298-7111
Practice Address - Street 1:100 EAST AVENUE A
Practice Address - Street 2:
Practice Address - City:KILLEAN
Practice Address - State:TX
Practice Address - Zip Code:76541
Practice Address - Country:US
Practice Address - Phone:254-526-4146
Practice Address - Fax:254-526-9351
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF19092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1166670 03Medicaid
TXB25611Medicare UPIN
TX1166670 03Medicaid