Provider Demographics
NPI:1811365406
Name:CAMPBELL, TERA (BCBA, LBA, LMHC)
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:BCBA, LBA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6312 KINGSTON PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919-4958
Mailing Address - Country:US
Mailing Address - Phone:910-849-5517
Mailing Address - Fax:
Practice Address - Street 1:1101 NIGHT CAP LN
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-8746
Practice Address - Country:US
Practice Address - Phone:910-849-5517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-13
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-17-28671103K00000X, 103K00000X
FLMH22376101YM0800X
FL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty