Basic Information
| Provider Information | |||||||||
| NPI: | 1154799419 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAMPBELL | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1805 INVERNESS AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489151284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167454045 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1805 INVERNESS AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6167454045 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2015 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 4101006659 | MI | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.