Healthcare Provider Details

I. General information

NPI: 1639305998
Provider Name (Legal Business Name): DR. ALEX R CAMPBELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALEX CAMPBELL PHD, BCBA, MFT

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 06/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

264 ARLINGTON AVE STE 2
KENSINGTON CA
94707-1416
US

IV. Provider business mailing address

185 DRAKEWOOD PL
NOVATO CA
94947-4681
US

V. Phone/Fax

Practice location:
  • Phone: 415-971-1186
  • Fax:
Mailing address:
  • Phone: 415-971-1186
  • Fax: 415-366-1685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC30244
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1084718
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: