Healthcare Provider Details

I. General information

NPI: 1932310711
Provider Name (Legal Business Name): CAMERON (CAMI) DAWN SMITH MT-BC, NMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 N 3RD ST STE 1000
PHOENIX AZ
85004-4605
US

IV. Provider business mailing address

1056 W MANHATTON DR
TEMPE AZ
85282-4617
US

V. Phone/Fax

Practice location:
  • Phone: 602-840-6410
  • Fax: 602-840-6431
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License NumberD01089846
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: