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Individual

MRS. MYRA IRENE CAMPBELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
111 BEVER GRADE, LAPWAI, ID 83540
(208) 843-2271
Mailing address
PO DRAWER 367, LAPWAI, ID 83540
(208) 843-2271
(208) 843-2102

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LAC-7239
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1000001
WA STATE LICENSE
WA
Enumeration date
03/29/2013
Last updated
06/03/2019
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