Provider Demographics
NPI:1528836244
Name:SHIVERS, CAMERON LAINE
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:LAINE
Last Name:SHIVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 E COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-7511
Mailing Address - Country:US
Mailing Address - Phone:214-263-3464
Mailing Address - Fax:
Practice Address - Street 1:8001 E COMMONS CT
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-7511
Practice Address - Country:US
Practice Address - Phone:214-263-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMHCA.MC.61513158101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health