Provider Demographics
NPI:1013127141
Name:CAMPBELL, STACY ANN (LPC, RPT)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:ANN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51485 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-9635
Mailing Address - Country:US
Mailing Address - Phone:208-577-1595
Mailing Address - Fax:
Practice Address - Street 1:25 NW PARK PL
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2954
Practice Address - Country:US
Practice Address - Phone:208-577-1595
Practice Address - Fax:541-640-5538
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5865101YM0800X
ORC6123101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health