Provider Demographics
NPI:1235010232
Name:CALVILLO, CAMERON RUSSELL
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:RUSSELL
Last Name:CALVILLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 12TH ST APT C
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-3040
Mailing Address - Country:US
Mailing Address - Phone:559-643-7181
Mailing Address - Fax:
Practice Address - Street 1:1500 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-4403
Practice Address - Country:US
Practice Address - Phone:800-207-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health