Provider Demographics
NPI:1760980437
Name:CAMPBELL FAMILY COUNSELING LLC
Entity Type:Organization
Organization Name:CAMPBELL FAMILY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-225-8588
Mailing Address - Street 1:2000 W PIONEER PKWY STE 6
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1883
Mailing Address - Country:US
Mailing Address - Phone:309-253-2471
Mailing Address - Fax:309-692-2052
Practice Address - Street 1:2000 W PIONEER PKWY STE 6
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1883
Practice Address - Country:US
Practice Address - Phone:309-253-2471
Practice Address - Fax:309-692-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0155861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty