=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114552981
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPENCER CAMPBELL MARRIAGE AND FAMILY THERAPY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2020
-----------------------------------------------------
Last Update Date | 09/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 908 TAYLORVILLE RD STE 205
-----------------------------------------------------
City | GRASS VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95949-9632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-334-0266
-----------------------------------------------------
Fax | 530-379-0142
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 908 TAYLORVILLE RD STE 205
-----------------------------------------------------
City | GRASS VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95949-9632
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-334-0266
-----------------------------------------------------
Fax | 530-379-0142
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SPENCER T CAMPBELL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 530-334-0266
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------