Provider Demographics
NPI:1447724554
Name:CAMPBELL, SIERAH (NCC, LPC-MSHP)
Entity type:Individual
Prefix:
First Name:SIERAH
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:NCC, LPC-MSHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 HARNETT CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2065
Mailing Address - Country:US
Mailing Address - Phone:615-438-3615
Mailing Address - Fax:
Practice Address - Street 1:204 HARNETT CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2065
Practice Address - Country:US
Practice Address - Phone:615-438-3615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4257OtherBOARD OF COUNSELORS AND MARRIAGE AND FAMILY THERAPISTS