MEDICARE: MR. JEFFREY SCOTT CAMPBELL M.A., L.M.F.T

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	38260	CA
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1669691341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEFFREY SCOTT CAMPBELL M.A., L.M.F.T

Provider Business Mailing Address
First Line	:	1757 MESA VERDE AVE # 240
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-6531
Country	:	US
Telephone Number	:	805-844-2991
Fax Number	:	805-671-5066

Provider Business Practice Location Address
First Line	:	3585 MAPLE ST
Second Line	:
City	:	VENTURA
State	:	CA
Zip	:	93003-3504
Country	:	US
Telephone Number	:	805-844-2991
Fax Number	:	805-671-5066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	07/08/2007

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