Provider Demographics
NPI:1811049042
Name:CAMPBELL, BOB A (MS LMLP)
Entity type:Individual
Prefix:MR
First Name:BOB
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:MS LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 HANEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2326
Mailing Address - Country:US
Mailing Address - Phone:785-628-8191
Mailing Address - Fax:785-628-1248
Practice Address - Street 1:208 EAST 7TH STREET
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-628-2871
Practice Address - Fax:785-628-1248
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP0021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0021OtherLMLP