Cameron Staley Phd LLC
Clinic/Center, Adult Mental Health in Chubbuck, ID. Organization (NPI-2).
NPI number1295589935
StatusActive
Last updated in NPPESApr 17, 2024
Details
- NPI
- 1295589935
- Entity type
- Organization (NPI-2)
- Legal business name
- Cameron Staley Phd LLC
- Organization subpart
- No
- Enumeration date
- Apr 17, 2024
- Certification date
- Apr 17, 2024
- Last updated
- Apr 17, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QM0850X | Clinic/Center, Adult Mental Health | – | – | Yes |
Practice location
5026 Cassie DrChubbuck, ID 83202-5252
Phone 801-644-2006
Mailing address
5026 Cassie DrChubbuck, ID 83202-5252
Phone 801-644-2006
Authorized official
Cameron Staley
Manager
2082695475
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