Healthcare Provider Details

I. General information

NPI: 1326963174
Provider Name (Legal Business Name): KRYSTAL CAMPBELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 WOODLAND SQUARE LOOP SE STE 301
LACEY WA
98503-1091
US

IV. Provider business mailing address

670 WOODLAND SQUARE LOOP SE STE 301
LACEY WA
98503-1091
US

V. Phone/Fax

Practice location:
  • Phone: 360-763-5828
  • Fax: 360-763-5828
Mailing address:
  • Phone: 360-763-5828
  • Fax: 360-763-5828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSWIA.SC.70030944
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: