Provider Demographics
NPI:1194850396
Name:CAMPBELL, ELOISE SHIRLEY (MFTI)
Entity Type:Individual
Prefix:MRS
First Name:ELOISE
Middle Name:SHIRLEY
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 INDEPENDENCE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-0210
Mailing Address - Country:US
Mailing Address - Phone:530-345-1600
Mailing Address - Fax:530-345-1685
Practice Address - Street 1:10 INDEPENDENCE CIR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-0210
Practice Address - Country:US
Practice Address - Phone:530-345-1600
Practice Address - Fax:530-345-1685
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41962106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist