Provider Demographics
NPI:1013204502
Name:CAMPBELL, VELMA LEE
Entity Type:Individual
Prefix:
First Name:VELMA
Middle Name:LEE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ALLIE YOUNG HALL
Mailing Address - Street 2:MSU CAUDILL HEALTH CLINIC
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-1179
Mailing Address - Country:US
Mailing Address - Phone:606-783-2055
Mailing Address - Fax:606-783-6877
Practice Address - Street 1:112 ALLIE YOUNG HALL
Practice Address - Street 2:MSU CAUDILL HEALTH CLINIC
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1179
Practice Address - Country:US
Practice Address - Phone:606-783-2055
Practice Address - Fax:606-783-6877
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0086103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling