Provider Demographics
NPI:1649232745
Name:CAMPBELL-HUME, NORA JEAN (ATR LCSW LPC)
Entity Type:Individual
Prefix:MRS
First Name:NORA
Middle Name:JEAN
Last Name:CAMPBELL-HUME
Suffix:
Gender:F
Credentials:ATR LCSW LPC
Other - Prefix:MRS
Other - First Name:NORA
Other - Middle Name:JEAN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR LCSW
Mailing Address - Street 1:9805 STATE ROAD C
Mailing Address - Street 2:
Mailing Address - City:MOKANE
Mailing Address - State:MO
Mailing Address - Zip Code:65059
Mailing Address - Country:US
Mailing Address - Phone:573-220-5595
Mailing Address - Fax:573-676-5001
Practice Address - Street 1:9805 STATE ROAD C
Practice Address - Street 2:
Practice Address - City:MOKANE
Practice Address - State:MO
Practice Address - Zip Code:65059
Practice Address - Country:US
Practice Address - Phone:573-220-5595
Practice Address - Fax:573-676-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO2004024101Y00000X
MO90120221700000X
MOMO0032981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493533525Medicaid