Provider Demographics
NPI:1154195915
Name:CAMPBELL, EMILY NOBU
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:NOBU
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:NOBU
Other - Last Name:FAIRCLOTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1160 DAMONTE RANCH PKWY UNIT 2026
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-4548
Mailing Address - Country:US
Mailing Address - Phone:909-282-2741
Mailing Address - Fax:
Practice Address - Street 1:6880 S MCCARRAN BLVD STE 6
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6129
Practice Address - Country:US
Practice Address - Phone:775-624-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI4267101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health