Healthcare Provider Details

I. General information

NPI: 1275470114
Provider Name (Legal Business Name): CAMERON VINCENT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N HOWARD ST # 7354
SPOKANE WA
99201-0508
US

IV. Provider business mailing address

100 N HOWARD ST # 7354
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 435-922-0274
  • Fax:
Mailing address:
  • Phone: 435-922-0274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14163735-3904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: