MEDICARE: MS. SARAH BETH CAMPBELL LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LCSW59908	CA

General Provider Information

NPI Number	:	1023137171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH BETH CAMPBELL LCSW

Provider Business Mailing Address
First Line	:	95280 STOCK SLOUGH LN
Second Line	:
City	:	COOS BAY
State	:	OR
Zip	:	97420-6350
Country	:	US
Telephone Number	:	559-786-0871
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 PARK AVE
Second Line	:	STE 2
City	:	COOS BAY
State	:	OR
Zip	:	97420-2242
Country	:	US
Telephone Number	:	559-374-2240
Fax Number	:	855-324-3730

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	03/29/2021

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