Provider Demographics
NPI:1780120584
Name:MEGAN J. CAMPBELL, ART THERAPY INC.
Entity type:Organization
Organization Name:MEGAN J. CAMPBELL, ART THERAPY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, ATR
Authorized Official - Phone:815-214-9754
Mailing Address - Street 1:750 ALMAR PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2315
Mailing Address - Country:US
Mailing Address - Phone:815-214-9754
Mailing Address - Fax:
Practice Address - Street 1:750 ALMAR PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2315
Practice Address - Country:US
Practice Address - Phone:815-214-9754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.009612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty