Provider Demographics
NPI:1376159541
Name:CAMPBELL, JILL CARYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:CARYN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5016 PARKWAY CALABASAS STE 212
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-3900
Mailing Address - Country:US
Mailing Address - Phone:818-879-6516
Mailing Address - Fax:
Practice Address - Street 1:342 OCHO RIOS WAY
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:CA
Practice Address - Zip Code:91377-5541
Practice Address - Country:US
Practice Address - Phone:818-879-6516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-22
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16098103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist