Healthcare Provider Details

I. General information

NPI: 1487275236
Provider Name (Legal Business Name): KAMERON MURRAY-LAVETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date: 10/12/2021
Reactivation Date: 02/28/2022

III. Provider practice location address

5502 NIKE DR
HILLIARD OH
43026-9081
US

IV. Provider business mailing address

1427 SCENIC CLUB DR
WESTERVILLE OH
43081-9523
US

V. Phone/Fax

Practice location:
  • Phone: 216-404-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberC.2405768
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: