Provider Demographics
NPI:1598581795
Name:CAMPBELL, SUSAN ELIANE
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELIANE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PPS CREDENTIAL
Mailing Address - Street 1:833 E MESQUITE AVE
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-8414
Mailing Address - Country:US
Mailing Address - Phone:760-416-8161
Mailing Address - Fax:
Practice Address - Street 1:833 E MESQUITE AVE
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-8414
Practice Address - Country:US
Practice Address - Phone:760-416-8161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-03
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool