Individual provider Active NPI

Emalynn Campbell

  • Marriage & Family Therapist
  • San Bernardino, CA
National Provider Identifier
1407399710
Registry record updated Jan 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
109367 Issued in CA
Practice address
572 N Arrowhead Ave Ste 100
San Bernardino, CA 92401-1217
Phone
(626) 278-0222
NPI assigned
Nov 18, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 23, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X 5032APCC CA
Marriage & Family Therapist 106H00000X 109367 CA Primary

Addresses

Primary practice location

572 N Arrowhead Ave Ste 100
San Bernardino, CA 92401-1217

Mailing address

160 E Holt Ave
B
Pomona, CA 91767-5406

Other practice location 1

14677 Merrill Avenue
Fontana, CA 92335
Phone (951) 643-2335

Other practice location 2

160 E Holt Ave
B
Pomona, CA 91767-5406
Phone (909) 620-2521

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5032APCCCAMDMental Health Counselor

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579737600000",
    "number": "1407399710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 E HOLT AVE",
            "address_2": "B",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917675406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "572 N ARROWHEAD AVE STE 100",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924011217",
            "telephone_number": "626-278-0222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "14677 Merrill Avenue",
            "address_purpose": "LOCATION",
            "city": "Fontana",
            "state": "CA",
            "postal_code": "92335",
            "country_code": "US",
            "telephone_number": "951-643-2335",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "160 E Holt Ave",
            "address_2": "B",
            "address_purpose": "LOCATION",
            "city": "Pomona",
            "state": "CA",
            "postal_code": "917675406",
            "country_code": "US",
            "telephone_number": "909-620-2521",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "EMALYNN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-18",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "5032APCC",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "109367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Bernardino, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.