Provider Demographics
NPI:1699976555
Name:CAMPBELL, JOHN RUSSELL (LCSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:RUSSELL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 BURT ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-1598
Mailing Address - Country:US
Mailing Address - Phone:402-991-5960
Mailing Address - Fax:
Practice Address - Street 1:11920 BURT ST
Practice Address - Street 2:SUITE 160
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-1598
Practice Address - Country:US
Practice Address - Phone:402-991-5960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE28791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical