Provider Demographics
NPI:1770283202
Name:CAMPBELL, TABITHA (PSYD)
Entity type:Individual
Prefix:
First Name:TABITHA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 N 100 W
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-2103
Mailing Address - Country:US
Mailing Address - Phone:801-910-2876
Mailing Address - Fax:
Practice Address - Street 1:1000 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-2069
Practice Address - Country:US
Practice Address - Phone:435-893-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12932743-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical