Provider Demographics
NPI:1174222632
Name:CAMPBELL, BROOKE (LCSW)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 450 BOX 375
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09705-0004
Mailing Address - Country:US
Mailing Address - Phone:047-084-8114
Mailing Address - Fax:
Practice Address - Street 1:5838 E ROLLING MEADOWS DR
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IN
Practice Address - Zip Code:47165-8911
Practice Address - Country:US
Practice Address - Phone:812-967-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34009539A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical