=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205448685
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KAILEY CAMPBELL LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2020
-----------------------------------------------------
Last Update Date | 05/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 NE ADAMS DAIRY PKWY
-----------------------------------------------------
City | BLUE SPRINGS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64014-5438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-988-2100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1402 SUSAN ST
-----------------------------------------------------
City | KEARNEY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64060-7507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 660-988-2100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 2020039407
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------