Healthcare Provider Details

I. General information

NPI: 1205826195
Provider Name (Legal Business Name): MARSHALL SCOTT CAMPBELL PSYD, LPC, CAC II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 N CASCADE AVE
MONTROSE CO
81401-3537
US

IV. Provider business mailing address

510 W 29TH ST
CHEYENNE WY
82001-2760
US

V. Phone/Fax

Practice location:
  • Phone: 970-252-3200
  • Fax:
Mailing address:
  • Phone: 307-426-4728
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1440
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2254
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: