Provider Demographics
NPI:1992128532
Name:JAMES B CAMPBELL LLC
Entity type:Organization
Organization Name:JAMES B CAMPBELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BURTON
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:954-707-9391
Mailing Address - Street 1:7501 NW 4TH ST
Mailing Address - Street 2:SUITE 215
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2245
Mailing Address - Country:US
Mailing Address - Phone:954-707-9391
Mailing Address - Fax:954-587-0982
Practice Address - Street 1:7501 NW 4TH ST
Practice Address - Street 2:SUITE 215
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2245
Practice Address - Country:US
Practice Address - Phone:954-707-9391
Practice Address - Fax:954-587-0982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8968103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty