Provider Demographics
NPI:1285841213
Name:CAMPBELL, WALTER RICHARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:RICHARD
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S JENNIE ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-1506
Mailing Address - Country:US
Mailing Address - Phone:559-733-4118
Mailing Address - Fax:
Practice Address - Street 1:568 E KERN AVE
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-4211
Practice Address - Country:US
Practice Address - Phone:559-684-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20253103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical