Camilo P Balacuit III III, AMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

142499 Issued in CA

Practice address

6601 Stephens Ranch Rd
Department of Mental Health
La Verne, CA 91750-1146

Phone

(626) 353-4912

NPI assigned

Mar 6, 2017

Last updated

Jun 5, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717545600000",
    "number": "1841730009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6601 STEPHENS RANCH RD",
            "address_2": "DEPARTMENT OF MENTAL HEALTH",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917501146",
            "telephone_number": "626-353-4912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6601 STEPHENS RANCH RD",
            "address_2": "DEPARTMENT OF MENTAL HEALTH",
            "city": "LA VERNE",
            "state": "CA",
            "postal_code": "917501146",
            "telephone_number": "626-353-4912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALACUIT III",
        "first_name": "CAMILO",
        "middle_name": "P",
        "name_suffix": "III",
        "credential": "AMFT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-06",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "142499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Avalos
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• B.M.E Medical Group
• Carl Eugene Bailey Jr., LCSW
• Dcorey Baines
• Eileen Patricia Banda, LVN
• Mark H Barak, MD
• Julio Barcelo Jr.
• Carmen A. Barr
• Stephanie Mireya Barrios

• Marriage & Family Therapist in La Verne, CA
• Providers in La Verne, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.