Provider Demographics
NPI:1770017246
Name:CAMPION, TERRAH (PYSCH TECH)
Entity Type:Individual
Prefix:
First Name:TERRAH
Middle Name:
Last Name:CAMPION
Suffix:
Gender:F
Credentials:PYSCH TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1919 APPLE ST STE G
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-4425
Mailing Address - Country:US
Mailing Address - Phone:760-547-1280
Mailing Address - Fax:
Practice Address - Street 1:1919 APPLE ST STE G
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-4425
Practice Address - Country:US
Practice Address - Phone:760-547-1280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT33534167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician