Healthcare Provider Details

I. General information

NPI: 1114552981
Provider Name (Legal Business Name): SPENCER CAMPBELL MARRIAGE AND FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 09/02/2025
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 TAYLORVILLE RD STE 205
GRASS VALLEY CA
95949-9632
US

IV. Provider business mailing address

908 TAYLORVILLE RD STE 205
GRASS VALLEY CA
95949-9632
US

V. Phone/Fax

Practice location:
  • Phone: 530-334-0266
  • Fax: 530-379-0142
Mailing address:
  • Phone: 530-334-0266
  • Fax: 530-379-0142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: SPENCER T CAMPBELL
Title or Position: OWNER
Credential:
Phone: 530-334-0266