Provider Demographics
NPI:1649743691
Name:WHITE, CAMERON CLARKE (MFT ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:CLARKE
Last Name:WHITE
Suffix:
Gender:M
Credentials:MFT ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 HILLROSE CT
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4827
Mailing Address - Country:US
Mailing Address - Phone:805-750-1978
Mailing Address - Fax:
Practice Address - Street 1:2021 SPERRY AVE STE 41
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7417
Practice Address - Country:US
Practice Address - Phone:805-669-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT109482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist