Provider Demographics
NPI:1528094810
Name:CAMON, EARTHA J (MA, LPC-S)
Entity type:Individual
Prefix:
First Name:EARTHA
Middle Name:J
Last Name:CAMON
Suffix:
Gender:F
Credentials:MA, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 S CROWLEY RD STE 9-348
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3686
Mailing Address - Country:US
Mailing Address - Phone:817-466-4450
Mailing Address - Fax:817-423-7706
Practice Address - Street 1:1459 CONLEY LN
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-1270
Practice Address - Country:US
Practice Address - Phone:817-466-4450
Practice Address - Fax:817-423-7706
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027934101Medicaid