Provider Demographics
NPI:1083716641
Name:CAMPBELL, ALAN CARL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:CARL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 W 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-5154
Mailing Address - Country:US
Mailing Address - Phone:405-372-1988
Mailing Address - Fax:405-624-1988
Practice Address - Street 1:2222 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5154
Practice Address - Country:US
Practice Address - Phone:405-372-1988
Practice Address - Fax:405-624-1988
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK589103TC1900X
OK652106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100841380AMedicaid