Healthcare Provider Details

I. General information

NPI: 1205743994
Provider Name (Legal Business Name): MARSHALL THOMAS CAMPBELL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 S 5TH ST STE 22
LEAVENWORTH KS
66048-2602
US

IV. Provider business mailing address

427 N 83RD PL
KANSAS CITY KS
66112-1917
US

V. Phone/Fax

Practice location:
  • Phone: 913-565-2131
  • Fax:
Mailing address:
  • Phone: 913-565-2131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number05545
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: