Provider Demographics
NPI:1154519122
Name:CAMPBELL, AMANDA JILL (LMHC)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:JILL
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CAMILLA CT
Mailing Address - Street 2:SUITE D
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9863
Mailing Address - Country:US
Mailing Address - Phone:618-554-2830
Mailing Address - Fax:
Practice Address - Street 1:120 CAMILLA CT
Practice Address - Street 2:SUITE D
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9863
Practice Address - Country:US
Practice Address - Phone:618-554-2830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
IN39002707A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL376006178008Medicaid
IL207184Medicare PIN
IL207184Medicare Oscar/Certification