Provider Demographics
NPI:1134479389
Name:CAMPBELL, JEFF
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:CAMPBELL
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:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92531-0549
Mailing Address - Country:US
Mailing Address - Phone:951-294-5879
Mailing Address - Fax:951-294-5806
Practice Address - Street 1:40329 STETSON AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-7358
Practice Address - Country:US
Practice Address - Phone:951-658-4466
Practice Address - Fax:951-765-2757
Is Sole Proprietor?:No
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)