Provider Demographics
NPI:1114240553
Name:CAMPBELL, EMILY R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:EMMA
Other - Middle Name:R
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:4611 S 96TH ST STE 251
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-1244
Mailing Address - Country:US
Mailing Address - Phone:402-885-5090
Mailing Address - Fax:402-575-9539
Practice Address - Street 1:4611 S 96TH ST STE 251
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-1244
Practice Address - Country:US
Practice Address - Phone:402-885-5090
Practice Address - Fax:402-575-9539
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE786103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1174188056OtherNPI