Provider Demographics
NPI:1184726689
Name:CAMERON, SUSAN B (LPC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:CAMERON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 OHIO DR STE 259
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-3990
Mailing Address - Country:US
Mailing Address - Phone:972-964-7730
Mailing Address - Fax:972-692-8692
Practice Address - Street 1:2301 OHIO DR STE 259
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3990
Practice Address - Country:US
Practice Address - Phone:972-964-7730
Practice Address - Fax:972-692-8692
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2009-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12736101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027251001Medicaid