Provider Demographics
NPI:1053788877
Name:BOSWELL, CAMILLE E (LPC)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:E
Last Name:BOSWELL
Suffix:
Gender:
Credentials:LPC
Other - Prefix:MISS
Other - First Name:CAMILLE
Other - Middle Name:
Other - Last Name:JUDKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72702-0324
Mailing Address - Country:US
Mailing Address - Phone:479-310-0061
Mailing Address - Fax:
Practice Address - Street 1:240 N BLOCK AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-5253
Practice Address - Country:US
Practice Address - Phone:479-310-0061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1801002101YM0800X
ARP1907087101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health