Provider Demographics
NPI:1679806269
Name:MCCAMPBELL, JANE L (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:L
Last Name:MCCAMPBELL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 RAYMOND AVE
Mailing Address - Street 2:SUITE 325
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1503
Mailing Address - Country:US
Mailing Address - Phone:612-414-0383
Mailing Address - Fax:952-926-3414
Practice Address - Street 1:821 RAYMOND AVE
Practice Address - Street 2:SUITE 325
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1503
Practice Address - Country:US
Practice Address - Phone:612-414-0383
Practice Address - Fax:952-926-3414
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-14
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1918106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist