Provider Demographics
NPI:1356627368
Name:CAMPBELL, ROBERT DEAN (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DEAN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15708 POMERADO RD
Mailing Address - Street 2:STE N-201
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2066
Mailing Address - Country:US
Mailing Address - Phone:858-487-4310
Mailing Address - Fax:760-294-6899
Practice Address - Street 1:15708 POMERADO RD
Practice Address - Street 2:STE N-201
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2066
Practice Address - Country:US
Practice Address - Phone:858-487-4310
Practice Address - Fax:760-294-6899
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23775106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist