Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY18661 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY18661 | CA |
NPI | 1013102763 |
---|---|
Provider Name | Dr. Kathleen Marie Campbell |
First Address | Los Angeles, CA 90068-1722 |
Second Address | Los Angeles, CA 90068-1722 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2007 |
Last Update Date | 06/09/2007 |