Provider Demographics
NPI:1598036501
Name:CAMPBELL, DEBRA A (MSW)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 S 64TH ST W
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-4538
Mailing Address - Country:US
Mailing Address - Phone:918-448-7052
Mailing Address - Fax:
Practice Address - Street 1:904 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-1653
Practice Address - Country:US
Practice Address - Phone:918-967-8223
Practice Address - Fax:918-967-8203
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200507310Medicaid