Provider Demographics
NPI:1215696885
Name:CAMPBELL, IRASEMA
Entity type:Individual
Prefix:
First Name:IRASEMA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 E MOUNTAIN VIEW AVE STE 501
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-4802
Mailing Address - Country:US
Mailing Address - Phone:509-426-3330
Mailing Address - Fax:
Practice Address - Street 1:700 E MOUNTAIN VIEW AVE STE 501
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-4802
Practice Address - Country:US
Practice Address - Phone:509-426-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health