Provider Demographics
NPI:1013166230
Name:CAMPBELL, MICHAEL (MA, MFTI)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 EL MONTE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9143
Mailing Address - Country:US
Mailing Address - Phone:530-588-8834
Mailing Address - Fax:
Practice Address - Street 1:107 PARMAC RD
Practice Address - Street 2:STE. 4
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-2298
Practice Address - Country:US
Practice Address - Phone:530-891-2850
Practice Address - Fax:530-895-6549
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAIMF 63304106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor