Edna Lea Campbell, LPC-S
Individual provider Active NPI Professional Counselor · Choctaw, OK
NPI 1104246867 · NPPES record last updated Nov 13, 2024
Key facts
- NPI
- 1104246867
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Professional Counselor 101YP2500X
- License
- P1609141 (AR)
- Practice address
- 2224 Apache St
Choctaw, OK 73020-3005 - Phone
- (708) 882-7484
- NPI assigned
- Apr 22, 2014
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250122000919 | OK | Practitioner - Mental Health Counselor | 4688103567 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P1609141 | AR | MD | Professional Counselor |
| 10228 | OK | MD | Urology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| This Is the Way Counseling, LLC | Current |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 10228 | OK | |
| Professional Counselor | 101YP2500X | P1609141 | AR | Yes |
Addresses
Primary practice location
2224 Apache St
Choctaw, OK 73020-3005
Mailing address
2224 Apache St
Choctaw, OK 73020-3005
Phone (708) 882-7484
Other names
- Edna Lea Thompson
Other providers in Choctaw, OK
- Bailey Brooks
- Samantha Lyne Brown
- Bruce a. Stafford, DO, PC
- Roger Lynn Bryant
- Molly Beth Bullard
- Maria Caram
- Stephanie Michelle Cargo
- Sabre Carlile
- Cary Lee Carpenter
- Carrie Carter
All providers in Choctaw, OK · Professional Counselor in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 13, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.