Provider Demographics
NPI:1437898137
Name:CAMPBELL, JESSICA LYNNE (MED, LPCA)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LYNNE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:LYNNE
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LPCA
Mailing Address - Street 1:628 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:PAINTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41240-1471
Mailing Address - Country:US
Mailing Address - Phone:606-205-7849
Mailing Address - Fax:
Practice Address - Street 1:628 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240-1471
Practice Address - Country:US
Practice Address - Phone:606-789-6966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
KY288551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator