Provider Demographics
NPI:1952789349
Name:CAMPBELL, TERRY (MA, LPCC)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:TERESE
Other - Last Name:CAMPBELL LINDEKE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:1917 W FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2410
Mailing Address - Country:US
Mailing Address - Phone:612-735-2259
Mailing Address - Fax:
Practice Address - Street 1:333 GRAND AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-2583
Practice Address - Country:US
Practice Address - Phone:651-294-2307
Practice Address - Fax:651-233-5641
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2019-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC02013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional