Provider Demographics
NPI:1578611059
Name:CAMPBELL, PEARL PURINO (MA)
Entity Type:Individual
Prefix:MRS
First Name:PEARL
Middle Name:PURINO
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 BEE TREE LN
Mailing Address - Street 2:PO BOX 84
Mailing Address - City:EAST ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62024-1609
Mailing Address - Country:US
Mailing Address - Phone:618-345-9536
Mailing Address - Fax:
Practice Address - Street 1:2014 VANDALIA ST.
Practice Address - Street 2:FAMILY LIFE CONSULTANTS
Practice Address - City:COLLINSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62234-4848
Practice Address - Country:US
Practice Address - Phone:618-345-9536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional