Provider Demographics
NPI:1801244413
Name:CAMPBELL, JOSEPH H III (MA, NCC, LPC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:H
Last Name:CAMPBELL
Suffix:III
Gender:M
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9721 S ALBANY AVE
Mailing Address - Street 2:UNIT 2
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-3120
Mailing Address - Country:US
Mailing Address - Phone:773-896-8160
Mailing Address - Fax:
Practice Address - Street 1:9721 S ALBANY AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-3120
Practice Address - Country:US
Practice Address - Phone:773-896-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178011116101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional