MEDICARE: MS. KIMBERLY BROWN CAMPBELL LCPC,ATR

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	1339-LCPC	MT

General Provider Information

NPI Number	:	1093953036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY BROWN CAMPBELL LCPC,ATR

Provider Business Mailing Address
First Line	:	511 EAST PINE STREET
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-4635
Country	:	US
Telephone Number	:	406-396-6565
Fax Number	:

Provider Business Practice Location Address
First Line	:	235 NORTH 1ST STREET WEST
Second Line	:	ZOOTOWN ARTS COMMUNITY CENTER
City	:	MISSOULA
State	:	MT
Zip	:	59802-3661
Country	:	US
Telephone Number	:	406-396-6565
Fax Number	:

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

Provider Enumeration Date	:	01/29/2009
Last Update Date	:	12/02/2011

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