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General NPI Number Information
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NPI Number | 1740643758
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Entity Type | Organization
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Legal Business Name | KIMBERLY BROWN CAMPBELL, EDD, LCPC, ATR, INC
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Dates
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Enumeration Date | 03/29/2016
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 235 N 1ST ST W SUITE 1
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City | MISSOULA
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State | MT
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Zip | 59802-3661
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Country | US
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Telephone | 406-396-6565
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Fax |
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Provider Business Mailing Address
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Address Line | 511 E PINE ST
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City | MISSOULA
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State | MT
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Zip | 59802-4635
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Country | US
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Telephone | 406-396-6565
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Fax |
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Authorized Official
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Title or Position | ART THERAPIST
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Name | DR. KIMBERLY BROWN CAMPBELL
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Credential | EDD
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Telephone | 406-396-6565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1339
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License Number State | MT
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