Provider Demographics
NPI:1811060270
Name:FARRELL-CAMPBELL, COLLEEN ANN (LMPCR)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:FARRELL-CAMPBELL
Suffix:
Gender:F
Credentials:LMPCR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5002 NE 40TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-2306
Mailing Address - Country:US
Mailing Address - Phone:360-737-9720
Mailing Address - Fax:
Practice Address - Street 1:3138 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:WASHOUGAL
Practice Address - State:WA
Practice Address - Zip Code:98671-2046
Practice Address - Country:US
Practice Address - Phone:360-608-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA16365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist