Individual
DR. CAMERON STALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYCHOLOGIST
Contact information
Practice address
5026 CASSIE DR, CHUBBUCK, ID 83202-5252
(801) 644-2006
Mailing address
5026 CASSIE DR, CHUBBUCK, ID 83202-5252
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
56668202501
UT
103TC0700X
Clinical Psychologist
Primary
PSY202707
ID
Other
Enumeration date
12/19/2022
Last updated
04/17/2024
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