MEDICARE: MRS. MARILYN MARGARET CAMERON MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401005997	MI

General Provider Information

NPI Number	:	1134130529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARILYN MARGARET CAMERON MA, LPC

Provider Business Mailing Address
First Line	:	6024 W MAPLE RD
Second Line	:	SUITE 107
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4405
Country	:	US
Telephone Number	:	248-489-1550
Fax Number	:	248-489-9767

Provider Business Practice Location Address
First Line	:	6024 W MAPLE RD
Second Line	:	SUITE 107
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-4405
Country	:	US
Telephone Number	:	248-489-1550
Fax Number	:	248-489-9767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	12/22/2009

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