Provider Demographics
NPI:1477543163
Name:CAMPBELL, JASON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENITALS
Mailing Address - Street 2:3851 ROGER BROOKE DR
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6200
Mailing Address - Country:US
Mailing Address - Phone:210-295-4094
Mailing Address - Fax:210-295-4416
Practice Address - Street 1:BROOKE ARMY MEDICAL CENTER, MCHE-QD/CREDENITALS
Practice Address - Street 2:3851 ROGER BROOKE DR
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-6200
Practice Address - Country:US
Practice Address - Phone:210-536-6349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005015537103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist