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General NPI Number Information
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NPI Number | 1760980437
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Entity Type | Organization
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Legal Business Name | CAMPBELL FAMILY COUNSELING LLC
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 01/29/2018
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Provider Practice Location Address
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Address Line | 2000 W PIONEER PKWY STE 6
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City | PEORIA
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State | IL
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Zip | 61615-1883
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Country | US
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Telephone | 309-253-2471
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Fax | 309-692-2052
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Provider Business Mailing Address
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Address Line | 2000 W PIONEER PKWY STE 6
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City | PEORIA
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State | IL
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Zip | 61615-1883
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Country | US
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Telephone | 309-253-2471
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Fax | 309-692-2052
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SHAWNA APPLE
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Credential |
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Telephone | 480-225-8588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.015586
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License Number State | IL
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