Healthcare Provider Details

I. General information

NPI: 1649232745
Provider Name (Legal Business Name): NORA JEAN CAMPBELL-HUME ATR LCSW LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NORA JEAN CAMPBELL ATR LCSW

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9805 STATE ROAD C
MOKANE MO
65059
US

IV. Provider business mailing address

9805 STATE ROAD C
MOKANE MO
65059
US

V. Phone/Fax

Practice location:
  • Phone: 573-220-5595
  • Fax: 573-676-5001
Mailing address:
  • Phone: 573-220-5595
  • Fax: 573-676-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMO2004024
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMO2004024
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number90120
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMO003298
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: