Provider Demographics
NPI:1750446308
Name:CAMPBELL, MARTHA MADRID (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:MADRID
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 1:5225 CANYON CREST DR
Mailing Address - Street 2:BLDG 100 STE 152
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507
Mailing Address - Country:US
Mailing Address - Phone:951-686-8646
Mailing Address - Fax:951-784-7640
Practice Address - Street 1:5225 CANYON CREST DR
Practice Address - Street 2:BLDG 100 STE 152
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507
Practice Address - Country:US
Practice Address - Phone:951-686-8646
Practice Address - Fax:951-784-7640
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist