Provider Demographics
NPI:1700337284
Name:BAXTER, CAMERON S (LMFT)
Entity Type:Individual
Prefix:
First Name:CAMERON
Middle Name:S
Last Name:BAXTER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 S WOODRUFF AVE STE B7
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-4866
Mailing Address - Country:US
Mailing Address - Phone:208-479-5402
Mailing Address - Fax:
Practice Address - Street 1:211 S WOODRUFF AVE STE B7
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-4866
Practice Address - Country:US
Practice Address - Phone:208-604-6489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMFT-7529106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist