Provider Demographics
NPI:1609050822
Name:CAMPBELL, SANDRA L (BS)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:L
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8758 S. WILLIAM CODY DR.
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439
Mailing Address - Country:US
Mailing Address - Phone:303-674-4741
Mailing Address - Fax:
Practice Address - Street 1:60615 US HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421-5053
Practice Address - Country:US
Practice Address - Phone:303-478-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health