Provider Demographics
NPI:1265912968
Name:CAMPBELL, ROBERT A (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22530 SE 64TH PL STE 220
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5353
Mailing Address - Country:US
Mailing Address - Phone:425-677-8686
Mailing Address - Fax:425-971-0783
Practice Address - Street 1:22530 SE 64TH PL STE 220
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5353
Practice Address - Country:US
Practice Address - Phone:425-677-8686
Practice Address - Fax:425-971-0783
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60880479101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health