Provider Demographics
NPI:1659393684
Name:CAMPBELL, LOWELL MASON III (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:LOWELL
Middle Name:MASON
Last Name:CAMPBELL
Suffix:III
Gender:M
Credentials:PSYD, LP
Other - Prefix:DR
Other - First Name:LOWELL
Other - Middle Name:MASON
Other - Last Name:CAMPBELL
Other - Suffix:III
Other - Last Name Type:Professional Name
Other - Credentials:PSYD LP
Mailing Address - Street 1:287 MARSCHALL RD STE 203
Mailing Address - Street 2:PO BOX 336
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1678
Mailing Address - Country:US
Mailing Address - Phone:952-445-1397
Mailing Address - Fax:952-445-1398
Practice Address - Street 1:287 MARSCHALL RD STE 203
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1678
Practice Address - Country:US
Practice Address - Phone:952-445-1397
Practice Address - Fax:952-445-1398
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP2631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01010981OtherPREFERRED ONE
MN61-20043OtherMEDICA ID
MN1346259041OtherIND NPI#
MN51217CAOtherBCBS GROUP ID
MN51053CAOtherBCBS ID
MNHP19455OtherHEALTHPARTNERS
MNC04321Medicare ID - Type UnspecifiedMEDICARE GROUP ID
MNR04998Medicare UPIN