Provider Demographics
NPI:1851021430
Name:CAMERON MENTAL HEALTH THERAPY & SUPPORTIVE SERVICES, LLC
Entity Type:Organization
Organization Name:CAMERON MENTAL HEALTH THERAPY & SUPPORTIVE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRIMARY THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:484-639-9447
Mailing Address - Street 1:470 BOOT RD UNIT 491
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-7023
Mailing Address - Country:US
Mailing Address - Phone:484-639-9447
Mailing Address - Fax:
Practice Address - Street 1:1583 MONTVALE CIR
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1560
Practice Address - Country:US
Practice Address - Phone:717-575-5902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14420257OtherAETNA