Provider Demographics
NPI:1114552981
Name:SPENCER CAMPBELL, MARRIAGE AND FAMILY THERAPIST, PROF CORP
Entity Type:Organization
Organization Name:SPENCER CAMPBELL, MARRIAGE AND FAMILY THERAPIST, PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:T
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:530-334-0266
Mailing Address - Street 1:908 TAYLORVILLE RD STE 205
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949-9632
Mailing Address - Country:US
Mailing Address - Phone:530-334-0266
Mailing Address - Fax:530-379-0142
Practice Address - Street 1:908 TAYLORVILLE RD STE 205
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-9632
Practice Address - Country:US
Practice Address - Phone:530-334-0266
Practice Address - Fax:530-379-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health