Malik Jameel Campbell

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

R7801 Issued in OR

Practice address

11 NE Martin Luther King Jr Blvd Ste 203
Portland, OR 97232-3579

Phone

(971) 350-1122

NPI assigned

Aug 23, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rebel Heart Therapy LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Portland, OR
  • NPI 1073146197

  Marriage & Family Therapist

  NPD

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

{
    "created_epoch": "1661212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661212800000",
    "number": "1699494773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11 NE MARTIN LUTHER KING JR BLVD STE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323579",
            "telephone_number": "971-350-1122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 NE MARTIN LUTHER KING JR BLVD STE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972323579",
            "telephone_number": "971-350-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "MALIK",
        "middle_name": "JAMEEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-23",
        "last_updated": "2022-08-23",
        "certification_date": "2022-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "R7801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "malik@rebelheartpdx.com",
            "affiliation": "N",
            "endpointDescription": "Office Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Office Email",
            "address_1": "11 NE Martin Luther King Jr Blvd Ste 203",
            "city": "Portland",
            "state": "OR",
            "country_code": "US",
            "postal_code": "972323579",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Keith A Campbell, PHD
• Kelly Stott Campbell, PT
• Kimberly Campbell, MPT
• Lacy Campbell, ND
• Lauren Jane Campbell
• Megan Meyer Campbell, MA
• Meghan Campbell, LPC
• Michelle Lynn Campbell, LAC
• Michelle Rose Campbell, MSW
• Nedine P Campbell, FNP

• Marriage & Family Therapist in Portland, OR
• Providers in Portland, OR by specialty
• Marriage & Family Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2022; 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.