Provider Demographics
NPI:1740823905
Name:CAMPBELL, JOHN (LMFT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 81ST DR SE
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-3192
Mailing Address - Country:US
Mailing Address - Phone:206-818-1351
Mailing Address - Fax:
Practice Address - Street 1:1121 81ST DR SE
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-3192
Practice Address - Country:US
Practice Address - Phone:206-818-1351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60607295106H00000X
WALF61067903106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist