Provider Demographics
NPI:1215647649
Name:CAMPBELL, KRISTY MARIE (LPC)
Entity type:Individual
Prefix:
First Name:KRISTY
Middle Name:MARIE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10628 160TH ST
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:MN
Mailing Address - Zip Code:56175-1924
Mailing Address - Country:US
Mailing Address - Phone:507-649-1894
Mailing Address - Fax:
Practice Address - Street 1:10628 160TH ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:MN
Practice Address - Zip Code:56175-1924
Practice Address - Country:US
Practice Address - Phone:507-649-1894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN02681101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor