Provider Demographics
NPI:1548064868
Name:KELLY, CAMERON E (MHCA)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:E
Last Name:KELLY
Suffix:
Gender:
Credentials:MHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 HARRIS AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-9301
Mailing Address - Country:US
Mailing Address - Phone:510-292-9273
Mailing Address - Fax:
Practice Address - Street 1:4350 CORDATA PKWY STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8278
Practice Address - Country:US
Practice Address - Phone:360-922-6977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMCHCA.MC.61659272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health