Healthcare Provider Details

I. General information

NPI: 1124705140
Provider Name (Legal Business Name): DANIELLE CAMPBELL BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 MAJOR AVE
RIVERTON WY
82501-2342
US

IV. Provider business mailing address

748 MAIN ST
LANDER WY
82520-3036
US

V. Phone/Fax

Practice location:
  • Phone: 307-856-6587
  • Fax:
Mailing address:
  • Phone: 307-332-2231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC-2610
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: