Provider Demographics
NPI:1558567859
Name:CAMPBELL, SARAH GATES (PHD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:GATES
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 30TH AVE N
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1325
Mailing Address - Country:US
Mailing Address - Phone:615-321-8400
Mailing Address - Fax:615-292-4716
Practice Address - Street 1:1018 17TH AVE S
Practice Address - Street 2:SUITE 7
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2214
Practice Address - Country:US
Practice Address - Phone:615-321-8400
Practice Address - Fax:615-292-4716
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical