Healthcare Provider Details

I. General information

NPI: 1154230480
Provider Name (Legal Business Name): ELLIE CATE CAMERON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 HAWTHORNE RD STE 3B
CHUBBUCK ID
83202-2376
US

IV. Provider business mailing address

405 KNUDSEN BLVD APT C345
CHUBBUCK ID
83202-1000
US

V. Phone/Fax

Practice location:
  • Phone: 208-252-5621
  • Fax:
Mailing address:
  • Phone: 208-705-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1981326
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: