Basic Information
| Provider Information | |||||||||
| NPI: | 1790290369 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMERON | ||||||||
| FirstName: | MARC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26131 MARGUERITE PKWY SUITE A | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92692 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498302846 | ||||||||
| FaxNumber: | 9516749635 | ||||||||
| Practice Location | |||||||||
| Address1: | 26131 MARGUERITE PKWY SUITE A | ||||||||
| Address2: | |||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926924400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498302846 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2017 | ||||||||
| LastUpdateDate: | 04/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 103518 | CA | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 103518 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.