Healthcare Provider Details

I. General information

NPI: 1134023567
Provider Name (Legal Business Name): ERIN CAMPBELL-BROOKS
Entity Type: Individual
Gender:
Sole Proprietor: Y

Provider Other Name: ERIN CAMPBELL

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 AIRWAY DR # 211
ALLEGAN MI
49010-9563
US

IV. Provider business mailing address

690 AIRWAY DR # 211
ALLEGAN MI
49010-9563
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-1799
  • Fax:
Mailing address:
  • Phone: 269-349-1799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361003265
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: