Provider Demographics
NPI:1891298303
Name:CAMPUSPSYCH LLC
Entity Type:Organization
Organization Name:CAMPUSPSYCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:503-744-7766
Mailing Address - Street 1:7710 OAKHILL RD APT F
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-6839
Mailing Address - Country:US
Mailing Address - Phone:440-552-2357
Mailing Address - Fax:
Practice Address - Street 1:4660 NE BELKNAP CT STE 101
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-8402
Practice Address - Country:US
Practice Address - Phone:503-744-7766
Practice Address - Fax:503-744-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-10
Last Update Date:2018-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty