Provider Demographics
NPI:1881208056
Name:CUSHING, CAMERON (CRC, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:CUSHING
Suffix:
Gender:M
Credentials:CRC, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 E PLYMPTON DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-9019
Mailing Address - Country:US
Mailing Address - Phone:208-941-5435
Mailing Address - Fax:
Practice Address - Street 1:3293 E PLYMPTON DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-9019
Practice Address - Country:US
Practice Address - Phone:208-890-2643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID7849101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional