Provider Demographics
NPI:1700900305
Name:CAMPBELL, STEPHEN KENNETH
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:KENNETH
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:PO BOX 892574
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92589-2574
Mailing Address - Country:US
Mailing Address - Phone:951-491-9806
Mailing Address - Fax:
Practice Address - Street 1:39755 MURRIETA HOT SPRINGS RD
Practice Address - Street 2:SUITE D-160
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-9101
Practice Address - Country:US
Practice Address - Phone:951-491-9806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 39337106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist