Provider Demographics
NPI:1538275839
Name:CAMPBELL, KATHERINE SHIELDS (MFT)
Entity type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:SHIELDS
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 BAKULA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-2625
Mailing Address - Country:US
Mailing Address - Phone:916-484-1374
Mailing Address - Fax:
Practice Address - Street 1:8233 E STOCKTON BLVD STE D
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-8203
Practice Address - Country:US
Practice Address - Phone:916-236-4751
Practice Address - Fax:916-405-6551
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40932106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist