Provider Demographics
NPI:1073205514
Name:SIBERT, CAMERON LEE (BS)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:LEE
Last Name:SIBERT
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 FERRY AVE APT C106
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6572
Mailing Address - Country:US
Mailing Address - Phone:253-319-9098
Mailing Address - Fax:
Practice Address - Street 1:3025 FERRY AVE APT C106
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6572
Practice Address - Country:US
Practice Address - Phone:253-319-9098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health