Doctor Name: | MRS. STACY ANN CAMPBELL |
NPI Number: | 1013127141 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | LPC-5156 |
Business Practice Address: | 3288 E Pine Ave Meridian, ID - 836425922 |
Business Phone Number: | 2088888886 |
Business Fax Number: | |
Mailing Address: | 3288 E Pine Ave, MERIDIAN |
State: | ID |
Postal Code: | 836425922 |
Phone Number: | 2088888886 |
Fax Number: | |
NPI Enumeration Date: | 05/24/2007 |
NPI Last Update Date: | 12/11/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPC-5156 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ID |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |