MEDICARE: CATHY A. CAMPBELL, LICSW, INC.

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	LW00007850	WA

General Provider Information

NPI Number	:	1528297496
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHY A. CAMPBELL, LICSW, INC.

Provider Business Mailing Address
First Line	:	402 E YAKIMA AVE
Second Line	:	SUITE 380
City	:	YAKIMA
State	:	WA
Zip	:	98901-5407
Country	:	US
Telephone Number	:	509-961-0775
Fax Number	:	509-457-2756

Provider Business Practice Location Address
First Line	:	402 E YAKIMA AVE
Second Line	:	SUITE 380
City	:	YAKIMA
State	:	WA
Zip	:	98901-5407
Country	:	US
Telephone Number	:	509-961-0775
Fax Number	:	509-457-2756

Authorized Official
Title or Position	:	LICSW
Name	:	MS. CATHY A CAMPBELL
Credential	:	MSW
Telephone Number	:	509-961-0775

Provider Enumeration Date	:	07/13/2009
Last Update Date	:	07/13/2009

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