| Doctor Name: | MR. TRACY DANIEL CAMPBELL |
| NPI Number: | 1861753493 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | CAS |
| License Number: | 03-084213 |
| Business Practice Address: | 5010 Shasta Dam Blvd Shasta Lake, CA - 960199406 |
| Business Phone Number: | 5302751076 |
| Business Fax Number: | 5302753717 |
| Mailing Address: | 5010 Shasta Dam Blvd, SHASTA LAKE |
| State: | CA |
| Postal Code: | 960199406 |
| Phone Number: | 5302751076 |
| Fax Number: | 5302753717 |
| NPI Enumeration Date: | 05/30/2012 |
| NPI Last Update Date: | 05/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 03-084213 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |