Active NPI
Tracy Daniel Campbell, CAS
- Addiction (Substance Use Disorder) Counselor
- Shasta Lake, CA
National Provider Identifier
1861753493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 03-084213
- Practice address
- 5010 Shasta Dam Blvd
Shasta Lake, CA 96019-9406 - Phone
- (530) 275-1076
- Fax
- (530) 275-3717
- NPI assigned
- May 30, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 03-084213 | CA | Primary |
Addresses
Primary practice location
5010 Shasta Dam Blvd
Shasta Lake, CA 96019-9406
Mailing address
5010 Shasta Dam Blvd
Shasta Lake, CA 96019-9406
Phone (530) 275-1076
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
| License | State | Type | Specialty |
|---|---|---|---|
| 03-084213 | CA | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338336000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338336000000",
"number": "1861753493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5010 SHASTA DAM BLVD",
"city": "SHASTA LAKE",
"state": "CA",
"postal_code": "960199406",
"telephone_number": "530-275-1076",
"fax_number": "530-275-3717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5010 SHASTA DAM BLVD",
"city": "SHASTA LAKE",
"state": "CA",
"postal_code": "960199406",
"telephone_number": "530-275-1076",
"fax_number": "530-275-3717"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CAMPBELL",
"first_name": "TRACY",
"middle_name": "DANIEL",
"name_prefix": "Mr.",
"credential": "CAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-05-30",
"last_updated": "2012-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CA",
"license": "03-084213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Shasta Lake, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.