Healthcare Provider Details

I. General information

NPI: 1205003530
Provider Name (Legal Business Name): HOLLY HAZARD CAMPBELL LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 NE 95TH ST RYTHER CHILD CENTER
SEATTLE WA
98115-2426
US

IV. Provider business mailing address

2400 NE 95TH ST RYTHER CHILD CENTER
SEATTLE WA
98115-2426
US

V. Phone/Fax

Practice location:
  • Phone: 206-525-5050
  • Fax: 206-525-9795
Mailing address:
  • Phone: 206-525-5050
  • Fax: 206-525-9795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH 60131178
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberRC00057344
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: