Provider Demographics
NPI:1063733764
Name:CAMPBELL, BRIAN K (LMFT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:K
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3149 N HWY 89
Mailing Address - Street 2:#303
Mailing Address - City:PLEASANT VIEW
Mailing Address - State:UT
Mailing Address - Zip Code:84404-1201
Mailing Address - Country:US
Mailing Address - Phone:801-782-6600
Mailing Address - Fax:801-782-6551
Practice Address - Street 1:3149 N HWY 89
Practice Address - Street 2:#303
Practice Address - City:PLEASANT VIEW
Practice Address - State:UT
Practice Address - Zip Code:84404-1201
Practice Address - Country:US
Practice Address - Phone:801-782-6600
Practice Address - Fax:801-782-6551
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT352006-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist