Provider Demographics
NPI:1831610518
Name:CAMPAS, LORI MICHELLE (LMSW)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:MICHELLE
Last Name:CAMPAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:GANADO
Mailing Address - State:AZ
Mailing Address - Zip Code:86505-0457
Mailing Address - Country:US
Mailing Address - Phone:928-755-4861
Mailing Address - Fax:928-755-4659
Practice Address - Street 1:US HIGHWAY 191 & AZ STATE ROUTE 264
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505-0457
Practice Address - Country:US
Practice Address - Phone:928-755-4861
Practice Address - Fax:928-755-4659
Is Sole Proprietor?:No
Enumeration Date:2017-07-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-16471104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLMSW-16471OtherAZ LICENSE FROM THE BOARD OF BEHAVIORAL HEALTH EXAMINERS