Provider Demographics
NPI:1366252934
Name:CAMPBELL, LORIE LYNN (MED, LMHCA)
Entity type:Individual
Prefix:
First Name:LORIE
Middle Name:LYNN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MED, LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 62ND ST SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-8026
Mailing Address - Country:US
Mailing Address - Phone:206-718-9932
Mailing Address - Fax:
Practice Address - Street 1:521 19TH AVE SW
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7465
Practice Address - Country:US
Practice Address - Phone:360-504-8276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61588924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty