Provider Demographics
NPI:1528467909
Name:CAMPBELL, CARRIE A (LPC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
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 1:38 KELLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2752
Mailing Address - Country:US
Mailing Address - Phone:660-988-6162
Mailing Address - Fax:660-626-1464
Practice Address - Street 1:2010 E NORMAL AVE
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-3321
Practice Address - Country:US
Practice Address - Phone:660-665-2834
Practice Address - Fax:660-626-1464
Is Sole Proprietor?:No
Enumeration Date:2014-08-21
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012024290101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional