Provider Demographics
NPI:1063804292
Name:BENNETT, CAMERON M (MS)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:M
Last Name:BENNETT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16283 E BELLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-4157
Mailing Address - Country:US
Mailing Address - Phone:785-491-1508
Mailing Address - Fax:888-570-3009
Practice Address - Street 1:16283 E BELLEVIEW DR
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-4157
Practice Address - Country:US
Practice Address - Phone:785-491-1508
Practice Address - Fax:888-570-3009
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLCMFT2813106H00000X
IDLMFT7180106H00000X
KSLMFT 2670106H00000X
MO2021026434106H00000X
CO0002580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist