Provider Demographics
NPI:1154844215
Name:CAMERON, CODI
Entity Type:Individual
Prefix:
First Name:CODI
Middle Name:
Last Name:CAMERON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CODI
Other - Middle Name:
Other - Last Name:CHAMBLESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1030
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-6030
Mailing Address - Country:US
Mailing Address - Phone:605-886-0123
Mailing Address - Fax:605-886-5447
Practice Address - Street 1:301 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-1901
Practice Address - Country:US
Practice Address - Phone:605-698-7688
Practice Address - Fax:605-886-5447
Is Sole Proprietor?:No
Enumeration Date:2017-07-20
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health