Provider Demographics
NPI:1124274469
Name:CAMPBELL, LEWIS E (LPE-I)
Entity type:Individual
Prefix:MR
First Name:LEWIS
Middle Name:E
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LPE-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 SOMERS AVE
Mailing Address - Street 2:P O BOX 94696
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7034
Mailing Address - Country:US
Mailing Address - Phone:501-771-9910
Mailing Address - Fax:501-758-7116
Practice Address - Street 1:4705 SOMERS AVE
Practice Address - Street 2:SUITE 1027
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7034
Practice Address - Country:US
Practice Address - Phone:501-771-9910
Practice Address - Fax:501-758-7116
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR82-30EI103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral