Provider Demographics
NPI:1851590327
Name:CAMPBELL, GARY DUANE (MED, LMFT, LMHC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:DUANE
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MED, LMFT, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7102 W LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-1240
Mailing Address - Country:US
Mailing Address - Phone:509-965-9592
Mailing Address - Fax:509-972-8216
Practice Address - Street 1:7102 W LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-1240
Practice Address - Country:US
Practice Address - Phone:509-965-9592
Practice Address - Fax:509-972-8216
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006028101YM0800X
WALF00001014106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health