Provider Demographics
NPI:1346259041
Name:DR. L M CAMPBELL, LTD
Entity Type:Organization
Organization Name:DR. L M CAMPBELL, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LOWELL
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:III
Authorized Official - Credentials:LP
Authorized Official - Phone:952-445-1378
Mailing Address - Street 1:287 SOUTH MARSCHALL ROAD
Mailing Address - Street 2:PO BOX 336 SUITE 203
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379
Mailing Address - Country:US
Mailing Address - Phone:952-445-1397
Mailing Address - Fax:952-445-1398
Practice Address - Street 1:287 SOUTH MARSCHALL ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379
Practice Address - Country:US
Practice Address - Phone:952-445-1397
Practice Address - Fax:952-445-1398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN51053CAOtherBCBS ID
MN61-20043OtherMEDICA ID
MN$$$$$$$$$OtherSOCIAL SECURITY
MN01010981OtherPREFERREDONE ID
MN1659393684OtherCORP NPI
MN51217CAOtherBCBS GROUP ID
MNHP19455OtherHEALTHPARTNERS ID
MN01010981OtherPREFERREDONE ID
MN61-20043OtherMEDICA ID