Provider Demographics
NPI:1538318415
Name:CAMPBELL, LARRY JAMES (LMFT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:JAMES
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 DOWNING ST.
Mailing Address - Street 2:
Mailing Address - City:MORRO BAY
Mailing Address - State:CA
Mailing Address - Zip Code:93442
Mailing Address - Country:US
Mailing Address - Phone:805-772-5780
Mailing Address - Fax:
Practice Address - Street 1:1264 HIGUERA ST
Practice Address - Street 2:#100
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3124
Practice Address - Country:US
Practice Address - Phone:805-542-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 36633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health