Provider Demographics
NPI:1386348969
Name:CAMPBELL, DEANNA ING
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:ING
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 SCOTT ROAD
Mailing Address - Street 2:
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514
Mailing Address - Country:US
Mailing Address - Phone:760-920-2013
Mailing Address - Fax:
Practice Address - Street 1:1360 N MAIN ST STE 114
Practice Address - Street 2:
Practice Address - City:BISHOP
Practice Address - State:CA
Practice Address - Zip Code:93514-3013
Practice Address - Country:US
Practice Address - Phone:760-872-1394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program