Provider Demographics
NPI:1407120843
Name:CAMPBELL, CURTIS WAYNE (LCSW, LSCSW)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:WAYNE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5119 NW 85TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64154-2793
Mailing Address - Country:US
Mailing Address - Phone:816-872-6656
Mailing Address - Fax:164-208-7108
Practice Address - Street 1:119 NE 72ND ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-1826
Practice Address - Country:US
Practice Address - Phone:816-872-6656
Practice Address - Fax:816-420-8710
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43771041C0700X
MO20140409471041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker