NPIMap

Organization Active NPI

Cameron Staley PHD LLC

  • Adult Mental Health Clinic/Center
  • Chubbuck, ID
National Provider Identifier
1295589935
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
Legal business name
CAMERON STALEY PHD LLC
Practice address
5026 Cassie Dr
Chubbuck, ID 83202-5252
Phone
(801) 644-2006
NPI assigned
Apr 17, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Cameron Staley, PHDNPI 1932811163
Title
Manager
Phone
(208) 269-5475

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X Primary

Addresses

Primary practice location

5026 Cassie Dr
Chubbuck, ID 83202-5252

Mailing address

5026 Cassie Dr
Chubbuck, ID 83202-5252
Phone (801) 644-2006

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1713312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1295589935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5026 CASSIE DR",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832025252",
            "telephone_number": "801-644-2006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5026 CASSIE DR",
            "city": "CHUBBUCK",
            "state": "ID",
            "postal_code": "832025252",
            "telephone_number": "801-644-2006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMERON STALEY PHD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-17",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "STALEY",
        "authorized_official_first_name": "CAMERON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "208-269-5475",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chubbuck, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.