Provider Demographics
NPI:1336684257
Name:CAMPBELL, CASEY (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:CASEY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4634 NE GARFIELD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-3313
Mailing Address - Country:US
Mailing Address - Phone:503-714-8762
Mailing Address - Fax:
Practice Address - Street 1:4634 NE GARFIELD AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-3313
Practice Address - Country:US
Practice Address - Phone:503-714-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-01
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR3136101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health