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General NPI Number Information
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NPI Number | 1104964436
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Entity Type | Individual
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Provider Name | KEITH A CAMPBELL PHD
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Gender | Male
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 1942 NW KEARNEY ST STE 24
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City | PORTLAND
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State | OR
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Zip | 97209-1465
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Country | US
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Telephone | 503-221-7074
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Fax | 503-636-8784
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Provider Business Mailing Address
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Address Line | 1942 NW KEARNEY ST STE 24
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City | PORTLAND
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State | OR
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Zip | 97209-1465
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Country | US
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Telephone | 503-221-7074
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Fax | 503-636-8784
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 619
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License Number State | OR
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