Provider Demographics
NPI:1144349788
Name:SERUM, CAMELLA S (PHD)
Entity type:Individual
Prefix:DR
First Name:CAMELLA
Middle Name:S
Last Name:SERUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 E STEWART RD
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-8587
Mailing Address - Country:US
Mailing Address - Phone:989-839-0950
Mailing Address - Fax:989-631-4705
Practice Address - Street 1:5103 EASTMAN AVE
Practice Address - Street 2:SUITE 237
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-6785
Practice Address - Country:US
Practice Address - Phone:989-839-0950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002342103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist