MEDICARE: MS. LORI 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	104100000X	Social Worker	7855-C	NV
2	1041C0700X	Clinical Social Worker	7855-C	NV

General Provider Information

NPI Number	:	1528420643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LORI CAMPBELL LCSW

Provider Business Mailing Address
First Line	:	4132 S RAINBOW BLVD # 108
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-3106
Country	:	US
Telephone Number	:	443-449-9034
Fax Number	:

Provider Business Practice Location Address
First Line	:	6263 W TWAIN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1153
Country	:	US
Telephone Number	:	443-449-9034
Fax Number	:

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

Provider Enumeration Date	:	03/28/2016
Last Update Date	:	01/29/2024

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