Provider Demographics
NPI:1285072041
Name:CAMPBELL, LYNN
Entity type:Individual
Prefix:MRS
First Name:LYNN
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 1:4214 W EL CAMPO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-3652
Mailing Address - Country:US
Mailing Address - Phone:702-359-0726
Mailing Address - Fax:702-359-0726
Practice Address - Street 1:1200 HELEN AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-3721
Practice Address - Country:US
Practice Address - Phone:702-636-9229
Practice Address - Fax:702-636-9229
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV461291354Medicaid