Provider Demographics
NPI:1689218711
Name:CAMPBELL, KATHERINE (PHD, LCPC, NCSP)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD, LCPC, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10526 W CERMAK RD
Mailing Address - Street 2:SUITE 308 AA
Mailing Address - City:WESTCHESTER
Mailing Address - State:IL
Mailing Address - Zip Code:60154
Mailing Address - Country:US
Mailing Address - Phone:312-502-8339
Mailing Address - Fax:
Practice Address - Street 1:10526 W CERMAK RD
Practice Address - Street 2:SUITE 308AA
Practice Address - City:WESTCHESTER
Practice Address - State:IL
Practice Address - Zip Code:60154
Practice Address - Country:US
Practice Address - Phone:872-444-6594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-31
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2018489103TS0200X
IL180.009238101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool