Provider Demographics
NPI:1205003530
Name:CAMPBELL, HOLLY HAZARD (LMHC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:HAZARD
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NE 95TH ST
Mailing Address - Street 2:RYTHER CHILD CENTER
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2426
Mailing Address - Country:US
Mailing Address - Phone:206-525-5050
Mailing Address - Fax:206-525-9795
Practice Address - Street 1:2400 NE 95TH ST
Practice Address - Street 2:RYTHER CHILD CENTER
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2426
Practice Address - Country:US
Practice Address - Phone:206-525-5050
Practice Address - Fax:206-525-9795
Is Sole Proprietor?:No
Enumeration Date:2008-05-15
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH 60131178101YM0800X
WARC00057344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional