Provider Demographics
NPI:1194542084
Name:CAMERON, KRISTY ELAINE (TLMHC)
Entity type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:ELAINE
Last Name:CAMERON
Suffix:
Gender:F
Credentials:TLMHC
Other - Prefix:
Other - First Name:KRIS
Other - Middle Name:
Other - Last Name:CAMERON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:TLMHC
Mailing Address - Street 1:375 COLLINS RD NE STE 16
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3168
Mailing Address - Country:US
Mailing Address - Phone:319-361-7673
Mailing Address - Fax:
Practice Address - Street 1:375 COLLINS RD NE STE 16
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3168
Practice Address - Country:US
Practice Address - Phone:319-361-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA125262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health