Provider Demographics
NPI:1336285238
Name:CAMPBELL, JEANNIE MOOD (LMFT)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:MOOD
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 LINDA LN
Mailing Address - Street 2:
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-3325
Mailing Address - Country:US
Mailing Address - Phone:541-236-4743
Mailing Address - Fax:541-605-0253
Practice Address - Street 1:1804 LINDA LN
Practice Address - Street 2:
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-3325
Practice Address - Country:US
Practice Address - Phone:541-236-4743
Practice Address - Fax:541-605-0253
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45366106H00000X
ORT1483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist