Provider Demographics
NPI:1083001432
Name:CAMPBELL, MCKENA (LPCC)
Entity Type:Individual
Prefix:MRS
First Name:MCKENA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MCKENA
Other - Middle Name:
Other - Last Name:TICHENOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCC
Mailing Address - Street 1:806 OUTER GRAY ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-1518
Mailing Address - Country:US
Mailing Address - Phone:270-302-5463
Mailing Address - Fax:
Practice Address - Street 1:1210 4TH ST
Practice Address - Street 2:
Practice Address - City:LEWISPORT
Practice Address - State:KY
Practice Address - Zip Code:42351-2526
Practice Address - Country:US
Practice Address - Phone:270-295-6450
Practice Address - Fax:270-295-6452
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-23
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY163108101Y00000X
KY173598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty