Provider Demographics
NPI:1538418728
Name:CAMACHO, CHELSEA NICOLE
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:NICOLE
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHELSEA
Other - Middle Name:NICOLE
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:IMF (CA)
Mailing Address - Street 1:1913 SANDALWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-2863
Mailing Address - Country:US
Mailing Address - Phone:805-720-3991
Mailing Address - Fax:
Practice Address - Street 1:201 W CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93458-4303
Practice Address - Country:US
Practice Address - Phone:805-922-2243
Practice Address - Fax:805-349-8165
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-03
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA76038101YM0800X, 171M00000X
CA113702106H00000X
CA145253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA113702OtherAMFT CALIFORNIA
CA76038OtherIMF CALIFORNIA