Organization
SUBURBAN COUNSELING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA MARIE CAMPBELL PHD (OWNER)
(414) 550-9350
Entity
Organization
Contact information
Practice address
1208 HWY 83, HARTLAND, WI 53029-8313
(414) 550-9350
(262) 369-7752
Mailing address
1208 HWY 83, HARTLAND, WI 53029-8313
(414) 550-9350
(262) 369-7752
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2243-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000002607
MEDICARE GROUP ID#:
WI
01
—
1889
STATE CERTIFICATION #:
WI
Enumeration date
06/07/2007
Last updated
02/24/2010
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