Provider Demographics
NPI:1174072284
Name:CAMPBELL, EMILY M (LPC)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:M
Other - Last Name:SILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1200 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:EFFINGHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62401-3032
Mailing Address - Country:US
Mailing Address - Phone:217-347-7179
Mailing Address - Fax:217-342-6716
Practice Address - Street 1:50 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1541
Practice Address - Country:US
Practice Address - Phone:608-643-3147
Practice Address - Fax:608-643-3178
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6963-125101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1174072284Medicaid