Provider Demographics
NPI:1528510021
Name:CLELAND, CAMERON
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:CLELAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 BIG NUGGET TRL
Mailing Address - Street 2:
Mailing Address - City:COOL
Mailing Address - State:CA
Mailing Address - Zip Code:95614-2200
Mailing Address - Country:US
Mailing Address - Phone:530-718-4970
Mailing Address - Fax:
Practice Address - Street 1:212 JUDAH ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2608
Practice Address - Country:US
Practice Address - Phone:916-572-8124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96481106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist