Provider Demographics
NPI:1609326560
Name:CAMPBELL, MAUREEN CAMILLE (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN CAMILLE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 GOUGH ST STE 403
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-5971
Mailing Address - Country:US
Mailing Address - Phone:415-906-4083
Mailing Address - Fax:415-885-2344
Practice Address - Street 1:110 GOUGH ST STE 403
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-5971
Practice Address - Country:US
Practice Address - Phone:415-906-4083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT100067106H00000X
CAIMF85015106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist