Provider Demographics
NPI:1982768313
Name:CAMPBELL, SPENCER T (MFT)
Entity type:Individual
Prefix:MR
First Name:SPENCER
Middle Name:T
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17024 OLD WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2365
Mailing Address - Country:US
Mailing Address - Phone:510-495-4047
Mailing Address - Fax:
Practice Address - Street 1:908 TAYLORVILLE RD
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95949-9632
Practice Address - Country:US
Practice Address - Phone:530-334-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45585106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1982768313OtherMEDICAL