Provider Demographics
NPI:1902948714
Name:CAMPBELL, FAYE H (MS, MFT)
Entity Type:Individual
Prefix:MS
First Name:FAYE
Middle Name:H
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 128
Mailing Address - Street 2:
Mailing Address - City:TETON VILLAGE
Mailing Address - State:WY
Mailing Address - Zip Code:83025-0128
Mailing Address - Country:US
Mailing Address - Phone:307-413-0215
Mailing Address - Fax:307-739-2219
Practice Address - Street 1:610 W. BROADWAY
Practice Address - Street 2:SUITE L02-J
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83002
Practice Address - Country:US
Practice Address - Phone:307-413-0215
Practice Address - Fax:307-739-2219
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY155106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist