Provider Demographics
NPI:1104671106
Name:CAMPBELL, JOSHUA S
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:S
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 STATE ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3583
Mailing Address - Country:US
Mailing Address - Phone:503-375-1523
Mailing Address - Fax:
Practice Address - Street 1:388 STATE ST STE 600
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-3583
Practice Address - Country:US
Practice Address - Phone:503-375-1523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR9063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health