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General NPI Number Information
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NPI Number | 1467072314
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Entity Type | Organization
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Legal Business Name | CAMILLE CAMPBELL A MARRIAGE AND FAMILY THERAPY CORPORATION
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Dates
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Enumeration Date | 04/21/2020
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 8170 BEVERLY BLVD STE 203
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City | LOS ANGELES
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State | CA
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Zip | 90048-4532
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Country | US
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Telephone | 310-897-0974
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Fax |
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Provider Business Mailing Address
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Address Line | 14470 GLORIETTA DR
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-4539
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Country | US
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Telephone | 310-897-0974
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CAMILLE CAMPBELL
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Credential | MFT
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Telephone | 424-279-8336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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