Basic Information
| Provider Information | |||||||||
| NPI: | 1013166230 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MA, MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 775 EL MONTE AVE | ||||||||
| Address2: | |||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959289143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305888834 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 107 PARMAC RD | ||||||||
| Address2: | STE. 4 | ||||||||
| City: | CHICO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959262298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308912850 | ||||||||
| FaxNumber: | 5308956549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2008 | ||||||||
| LastUpdateDate: | 04/02/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 106H00000X | IMF 63304 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.