Healthcare Provider Details

I. General information

NPI: 1013838655
Provider Name (Legal Business Name): CAMPBELL L MCGOWAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 N F ST
SAN BERNARDINO CA
92410-3017
US

IV. Provider business mailing address

2094 MESQUITE AVE UNIT 109
LAKE HAVASU CITY AZ
86403-6738
US

V. Phone/Fax

Practice location:
  • Phone: 909-381-1100
  • Fax:
Mailing address:
  • Phone: 951-966-2813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: