Provider Demographics
NPI:1265659650
Name:CAMPBELL, SCOTT D (LCPC)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:D
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 COOLIDGE PL
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-4936
Mailing Address - Country:US
Mailing Address - Phone:815-742-5562
Mailing Address - Fax:815-315-6045
Practice Address - Street 1:1300 17TH ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104-5629
Practice Address - Country:US
Practice Address - Phone:815-742-5562
Practice Address - Fax:815-315-6045
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional