Organization
CAMERON STALEY PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAMERON STALEY PHD (MANAGER)
(208) 269-5475
Entity
Organization
Contact information
Practice address
5026 CASSIE DR, CHUBBUCK, ID 83202-5252
(801) 644-2006
Mailing address
5026 CASSIE DR, CHUBBUCK, ID 83202-5252
(801) 644-2006
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
04/17/2024
Last updated
04/17/2024
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