Provider Demographics
NPI:1386776706
Name:CAMPBELL, TRISHA M I (LISW)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:M
Last Name:CAMPBELL
Suffix:I
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:TRISHA
Other - Middle Name:M
Other - Last Name:PICKENPAUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:145 MORRIS RD
Mailing Address - Street 2:SPVMHC
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1363
Mailing Address - Country:US
Mailing Address - Phone:740-474-8874
Mailing Address - Fax:740-474-1463
Practice Address - Street 1:145 MORRIS RD
Practice Address - Street 2:SPVMHC
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1363
Practice Address - Country:US
Practice Address - Phone:740-474-8874
Practice Address - Fax:740-477-1463
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.07002051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258OtherMACSIS