Provider Demographics
NPI:1457666265
Name:CAMPBELL, MELVIN (MHPP)
Entity Type:Individual
Prefix:
First Name:MELVIN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 DORSET DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72204-4214
Mailing Address - Country:US
Mailing Address - Phone:501-231-6392
Mailing Address - Fax:
Practice Address - Street 1:34011 HIGHWAY 300
Practice Address - Street 2:
Practice Address - City:BIGELOW
Practice Address - State:AR
Practice Address - Zip Code:72016-5200
Practice Address - Country:US
Practice Address - Phone:501-330-1225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator