Provider Demographics
NPI:1992291108
Name:CAMPBELL, KAREN M (LMHC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 S CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46802-2601
Mailing Address - Country:US
Mailing Address - Phone:260-422-5625
Mailing Address - Fax:
Practice Address - Street 1:10102 WOODLAND PLAZA CV
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1569
Practice Address - Country:US
Practice Address - Phone:260-422-5625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002733A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1811047608Medicaid
IN1447798889Medicaid
IN300080965Medicaid
IN300068777Medicaid