Healthcare Provider Details

I. General information

NPI: 1093327645
Provider Name (Legal Business Name): TERESA ANN CAMPBELL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 S PACIFIC ST
CAPE GIRARDEAU MO
63703-7841
US

IV. Provider business mailing address

2535 RANCHITO DR
CAPE GIRARDEAU MO
63701-3630
US

V. Phone/Fax

Practice location:
  • Phone: 573-270-1003
  • Fax:
Mailing address:
  • Phone: 573-270-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License NumberSMA-00121
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2020021219
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: