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General NPI Number Information
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NPI Number | 1306178918
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Entity Type | Individual
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Provider Name | JENNIFER PATRICIA CAMPBELL MA, LPC, CCDP-D
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Gender | Female
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Dates
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Enumeration Date | 02/06/2010
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Last Update Date | 02/06/2010
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Provider Practice Location Address
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Address Line | 939 GARDENVIEW OFFICE PKWY
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City | CREVE COEUR
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State | MO
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Zip | 63141-5917
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Country | US
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Telephone | 314-566-2290
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Fax |
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Provider Business Mailing Address
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Address Line | 9433 THEODOSIA AVE
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City | OVERLAND
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State | MO
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Zip | 63114-3715
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Country | US
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Telephone | 314-566-2290
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 2008010475
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5030
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2008010475
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License Number State | MO
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