Provider Demographics
NPI:1588766984
Name:CAMPBELL, CYNTHIA LOUISE (MA MFT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LOUISE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24050 MADISON ST
Mailing Address - Street 2:STE 104
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505
Mailing Address - Country:US
Mailing Address - Phone:310-378-3355
Mailing Address - Fax:310-378-2384
Practice Address - Street 1:24050 MADISON ST
Practice Address - Street 2:STE 104
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-378-3355
Practice Address - Fax:310-378-2384
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC28939106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist