Provider Demographics
NPI:1093953036
Name:CAMPBELL, KIMBERLY BROWN (LCPC,ATR)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:BROWN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCPC,ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 EAST PINE STREET
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4635
Mailing Address - Country:US
Mailing Address - Phone:406-396-6565
Mailing Address - Fax:
Practice Address - Street 1:235 NORTH 1ST STREET WEST
Practice Address - Street 2:ZOOTOWN ARTS COMMUNITY CENTER
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3661
Practice Address - Country:US
Practice Address - Phone:406-396-6565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2011-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1339-LCPC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health