Healthcare Provider Details

I. General information

NPI: 1811559941
Provider Name (Legal Business Name): DONALD LLOYD CAMPBELL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 06/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 W 3RD AVE
SPOKANE WA
99201-5809
US

IV. Provider business mailing address

12310 E MACY CT. ADDRESS 2 (OPTIONAL)
SPOKANE VALLEY WA
99216-0348
US

V. Phone/Fax

Practice location:
  • Phone: 509-624-1244
  • Fax:
Mailing address:
  • Phone: 509-999-5545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberINTERN
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: