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General NPI Number Information
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NPI Number | 1427455179
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Entity Type | Individual
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Provider Name | LORI K CAMPBELL PH.D., HSPP
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Gender | Female
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 04/14/2015
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Provider Practice Location Address
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Address Line | 3925 E HAGAN ST, STE 102
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City | BLOOMINGTON
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State | IN
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Zip | 47401-8649
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Country | US
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Telephone | 812-336-1994
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Fax |
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Provider Business Mailing Address
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Address Line | 3925 E HAGAN ST, STE 102
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City | BLOOMINGTON
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State | IN
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Zip | 47401-8649
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Country | US
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Telephone | 812-336-1994
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 20041374A
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License Number State | IN
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