Provider Demographics
NPI:1710929567
Name:CAMPBELL-MILLER, LAURIE A (MS, LLP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:A
Last Name:CAMPBELL-MILLER
Suffix:
Gender:F
Credentials:MS, LLP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LLP
Mailing Address - Street 1:31815 SOUTHFIELD RD STE 18
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-5471
Mailing Address - Country:US
Mailing Address - Phone:248-480-0115
Mailing Address - Fax:248-282-7114
Practice Address - Street 1:31815 SOUTHFIELD RD STE 18
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:MI
Practice Address - Zip Code:48025-5471
Practice Address - Country:US
Practice Address - Phone:248-480-0115
Practice Address - Fax:248-282-7114
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI012917103T00000X
MI6361003493103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1710929567Medicaid