Provider Demographics
NPI:1669245114
Name:ALLDREDGE, CAMERON TODD (PHD)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:TODD
Last Name:ALLDREDGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 LINDENWOOD LN N
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-3035
Mailing Address - Country:US
Mailing Address - Phone:801-376-3202
Mailing Address - Fax:
Practice Address - Street 1:801 WASHINGTON AVE # 260.02
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1282
Practice Address - Country:US
Practice Address - Phone:254-265-8893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13021318-2501103TC0700X
TX39810103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical