Provider Demographics
NPI:1780431148
Name:CAMPBELL, JAIMESON RACHEL (LPC)
Entity type:Individual
Prefix:
First Name:JAIMESON
Middle Name:RACHEL
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2890 BROOKMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-7114
Mailing Address - Country:US
Mailing Address - Phone:636-577-0338
Mailing Address - Fax:
Practice Address - Street 1:500 HUBER PARK CT STE 203
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-8683
Practice Address - Country:US
Practice Address - Phone:636-706-5750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021029133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty