MEDICARE: TERRY CAMPBELL MA, LPCC

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	101YP2500X	Professional Counselor	CC02013	MN

General Provider Information

NPI Number	:	1952789349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY CAMPBELL MA, LPCC

Provider Business Mailing Address
First Line	:	1917 W FRANKLIN AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55405-2410
Country	:	US
Telephone Number	:	612-735-2259
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 GRAND AVE STE 204
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-2583
Country	:	US
Telephone Number	:	651-294-2307
Fax Number	:	651-233-5641

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

Provider Enumeration Date	:	05/18/2015
Last Update Date	:	04/13/2019

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