Provider Demographics
NPI:1760201818
Name:JUSTEN, CAMERON
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:
Last Name:JUSTEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CHERRYHILL CT
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-1731
Mailing Address - Country:US
Mailing Address - Phone:815-245-7087
Mailing Address - Fax:
Practice Address - Street 1:650 E TERRA COTTA AVE
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3653
Practice Address - Country:US
Practice Address - Phone:815-979-2580
Practice Address - Fax:815-354-3517
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178020610101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional