Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MC60275036 | WA |
NPI | 1003246331 |
---|---|
Provider Name | Clinton Jay Campbell |
First Address | Seattle, WA 98107-3900 |
Second Address | Seattle, WA 98107-3900 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2013 |
Last Update Date | 22/11/2013 |