Healthcare Provider Details

I. General information

NPI: 1215754502
Provider Name (Legal Business Name): CAMERON BEACHY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7317 PORTAGE ST NW
MASSILLON OH
44646-7827
US

IV. Provider business mailing address

7317 PORTAGE ST NW
MASSILLON OH
44646-7827
US

V. Phone/Fax

Practice location:
  • Phone: 330-966-1620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2513073
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: