Provider Demographics
NPI:1639436207
Name:CAMERON, MARY ELIZABETH (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219182
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-9182
Mailing Address - Country:US
Mailing Address - Phone:503-484-3027
Mailing Address - Fax:503-620-4673
Practice Address - Street 1:6745 SW HAMPTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8394
Practice Address - Country:US
Practice Address - Phone:503-484-3027
Practice Address - Fax:503-620-4673
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC 2775101YP2500X
ORT 0811106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional