Provider Demographics
NPI:1437438181
Name:CAMPBELL, WALTER LAWRENCE (M S)
Entity Type:Individual
Prefix:MR
First Name:WALTER
Middle Name:LAWRENCE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:M S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6332 E BENDER RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9217
Mailing Address - Country:US
Mailing Address - Phone:812-336-4946
Mailing Address - Fax:
Practice Address - Street 1:600 N. JORDAN AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47405
Practice Address - Country:US
Practice Address - Phone:812-855-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor