Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TC1900X | Counseling Psychologist | 589 | OK |
NPI | 1083716641 |
---|---|
Provider Name | Dr. Alan Carl Campbell |
First Address | Stillwater, OK 74074-5154 |
Second Address | Stillwater, OK 74074-5154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100841380A | (05) | OK |