Provider Demographics
NPI:1093960528
Name:CAMPBELL, AMMON SEAN (LMHC, NCC, DCC)
Entity Type:Individual
Prefix:
First Name:AMMON
Middle Name:SEAN
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMHC, NCC, DCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 W 1640 N
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8988
Mailing Address - Country:US
Mailing Address - Phone:845-662-6414
Mailing Address - Fax:
Practice Address - Street 1:1076 W 1640 N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8988
Practice Address - Country:US
Practice Address - Phone:845-662-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60025510101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health