Basic Information
| Provider Information | |||||||||
| NPI: | 1245223270 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | ROSS | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 444 W 21ST AVE | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992031943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096243539 | ||||||||
| FaxNumber: | 5096243539 | ||||||||
| Practice Location | |||||||||
| Address1: | 105 W 8TH AVE | ||||||||
| Address2: | SUITE 332 | ||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098387400 | ||||||||
| FaxNumber: | 5092838682 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2005 | ||||||||
| LastUpdateDate: | 07/10/2007 | ||||||||
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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 | 103G00000X | PY00001459 | WA | Y | Behavioral Health & Social Service Providers | Clinical Neuropsychologist | 103TC0700X | PY00001459 | WA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TF0200X | PY00001459 | WA | N | Behavioral Health & Social Service Providers | Psychologist | Forensic |
No ID Information.