Healthcare Provider Details

I. General information

NPI: 1427791862
Provider Name (Legal Business Name): CAMERON CAULEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/14/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 W ORION ST STE C-3
TEMPE AZ
85283-5603
US

IV. Provider business mailing address

19179 N PICCOLO DR
MARICOPA AZ
85138-4317
US

V. Phone/Fax

Practice location:
  • Phone: 480-597-8121
  • Fax:
Mailing address:
  • Phone: 725-225-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: