Provider Demographics
NPI:1689877334
Name:CAMPBELL, KRISTINE R (LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 17TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3356
Mailing Address - Country:US
Mailing Address - Phone:510-679-9964
Mailing Address - Fax:510-201-1696
Practice Address - Street 1:337 17TH ST STE 210
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3356
Practice Address - Country:US
Practice Address - Phone:510-679-9964
Practice Address - Fax:510-201-1696
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42863106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11811078OtherCAQH