Provider Demographics
NPI:1821143975
Name:CAMPBELL, TREVIN J
Entity Type:Individual
Prefix:
First Name:TREVIN
Middle Name:J
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 402 BOX 104, APO, AE - 09180
Mailing Address - Street 2:AUF DER PLATTE 64
Mailing Address - City:MACKENBACH
Mailing Address - State:RHINELAND PFALZ
Mailing Address - Zip Code:67686
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUHL REGIONAL MEDICAL CENTER
Practice Address - Street 2:UNIT 33100 APO AE 09180-3100
Practice Address - City:LANDSTUHL
Practice Address - State:RHINELAND PFALZ
Practice Address - Zip Code:09180
Practice Address - Country:DE
Practice Address - Phone:314-590-7789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA253106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist