Provider Demographics
NPI:1063199594
Name:CAMPOS, ANGELICA MARIA
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:MARIA
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ANGELICA
Other - Middle Name:MARIA
Other - Last Name:CAMPOS-HEALON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 523
Mailing Address - Street 2:
Mailing Address - City:WILLAMINA
Mailing Address - State:OR
Mailing Address - Zip Code:97396-0523
Mailing Address - Country:US
Mailing Address - Phone:541-921-8039
Mailing Address - Fax:
Practice Address - Street 1:435 NE EVANS ST STE A
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4635
Practice Address - Country:US
Practice Address - Phone:206-901-1685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No175T00000XOther Service ProvidersPeer Specialist