Provider Demographics
NPI:1013102763
Name:CAMPBELL, KATHLEEN MARIE (PSY D07)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PSY D07
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7245 SYCAMORE TRL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1722
Mailing Address - Country:US
Mailing Address - Phone:323-851-3149
Mailing Address - Fax:323-851-9919
Practice Address - Street 1:7245 SYCAMORE TRL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1722
Practice Address - Country:US
Practice Address - Phone:323-851-3149
Practice Address - Fax:323-851-9919
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18661103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical