Healthcare Provider Details

I. General information

NPI: 1477185577
Provider Name (Legal Business Name): DEIDRE CAMPEN MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2020
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 1ST AVE NW
FAIRFAX MN
55332-3168
US

IV. Provider business mailing address

4890 GRANT VALLEY RD NW
BEMIDJI MN
56601-5383
US

V. Phone/Fax

Practice location:
  • Phone: 218-333-2220
  • Fax:
Mailing address:
  • Phone: 352-476-1845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC014124
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number02328
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: