Provider Demographics
NPI:1093186561
Name:CAMPBELL, SCOTT (LPCC, MS ED)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:
Credentials:LPCC, MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 PRESIDENTIAL WAY
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-5765
Mailing Address - Country:US
Mailing Address - Phone:326-202-9292
Mailing Address - Fax:
Practice Address - Street 1:4609 PRESIDENTIAL WAY
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-5765
Practice Address - Country:US
Practice Address - Phone:326-202-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-09
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1700477-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health