Provider Demographics
NPI:1134246622
Name:CAMPBELL, PAMELA G
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:G
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 E BISMARCK EXPY
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-6744
Mailing Address - Country:US
Mailing Address - Phone:701-255-3325
Mailing Address - Fax:
Practice Address - Street 1:1833 E BISMARCK EXPY STE 2
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-6745
Practice Address - Country:US
Practice Address - Phone:701-255-3325
Practice Address - Fax:701-250-6469
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 52041106H00000X
ND2022-086106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist