Provider Demographics
NPI:1588322366
Name:CAMPBELL, CHAD MICHAEL (QMHA)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:MICHAEL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:393 WALKER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2313
Mailing Address - Country:US
Mailing Address - Phone:541-816-6061
Mailing Address - Fax:
Practice Address - Street 1:503 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4159
Practice Address - Country:US
Practice Address - Phone:541-200-2900
Practice Address - Fax:541-200-2948
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health