Provider Demographics
NPI:1255170742
Name:CAMPBELL, TRISCHELLE D
Entity type:Individual
Prefix:
First Name:TRISCHELLE
Middle Name:D
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 1:4552 BULRUSH CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45404-3501
Mailing Address - Country:US
Mailing Address - Phone:937-287-1061
Mailing Address - Fax:
Practice Address - Street 1:118 W 1ST ST STE 820
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-1150
Practice Address - Country:US
Practice Address - Phone:937-770-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-23
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH21706034101YS0200X
OHS00119273104100000X
OHC00119273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker