=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861205833
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COURTNEY CAMPBELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2025
-----------------------------------------------------
Last Update Date | 08/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 401 WOODLAND HILLS BLVD
-----------------------------------------------------
City | FORT SCOTT
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66701-8797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-223-5030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1106 S 9TH ST
-----------------------------------------------------
City | HUMBOLDT
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66748-1934
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-473-2241
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------