Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TB0200X | Cognitive & Behavioral Psychologist | 29401 | CA |
Y | 103G00000X | Clinical Psychologist | 29401 | CA |
Y | 103TC0700X | Clinical Psychologist | 29401 | CA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 29401 | CA |
NPI | 1154737948 |
---|---|
Provider Name | Dr. Kristin Read Campos |
First Address | Atascadero, CA 93422-7227 |
Second Address | Atascadero, CA 93422-7227 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 24/10/2021 |