Healthcare Provider Details

I. General information

NPI: 1578780409
Provider Name (Legal Business Name): LLOYD NELSON CAMPBELL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7080 SW FIR LOOP
TIGARD OR
97223-8149
US

IV. Provider business mailing address

22827 SW HOSLER WAY
SHERWOOD OR
97140-7745
US

V. Phone/Fax

Practice location:
  • Phone: 503-620-1191
  • Fax: 503-620-3940
Mailing address:
  • Phone: 503-625-9891
  • Fax: 503-620-3940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL2769
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: