Provider Demographics
NPI:1801143292
Name:CAMPBELL, ALLYSON MAREE (LCSW, LMHP)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:MAREE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW, LMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 S 166TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130-1324
Mailing Address - Country:US
Mailing Address - Phone:870-706-9855
Mailing Address - Fax:
Practice Address - Street 1:18025 OAK STREET SUITE A
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130-4423
Practice Address - Country:US
Practice Address - Phone:402-671-0889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-06
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8274-C1041C0700X
NE2537104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026903900Medicaid
AR227582719Medicaid