Basic Information
| Provider Information | |||||||||
| NPI: | 1013204502 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | VELMA | ||||||||
| MiddleName: | LEE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 112 ALLIE YOUNG HALL | ||||||||
| Address2: | MSU CAUDILL HEALTH CLINIC | ||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067832055 | ||||||||
| FaxNumber: | 6067836877 | ||||||||
| Practice Location | |||||||||
| Address1: | 112 ALLIE YOUNG HALL | ||||||||
| Address2: | MSU CAUDILL HEALTH CLINIC | ||||||||
| City: | MOREHEAD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403511179 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067832055 | ||||||||
| FaxNumber: | 6067836877 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 07/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | KY-0086 | KY | Y | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.