Willie Campbell Jr., MS TLLP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301016973 Issued in MI

Practice address

5575 Conner St
Detroit, MI 48213-6400

Phone

(313) 643-5542

Fax

(248) 522-7045

NPI assigned

Nov 27, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1511740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1511740800000",
    "number": "1124532296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21575 DUNS SCOTUS ST",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753226",
            "telephone_number": "313-595-9039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5575 CONNER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482136400",
            "telephone_number": "313-643-5542",
            "fax_number": "248-522-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMPBELL",
        "first_name": "WILLIE",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "MS TLLP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-11-27",
        "last_updated": "2017-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301016973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6301016973",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rachel Marie Campbell, PA-C
• Sharena Campbell
• Shelley Jean Campbell, CNNP
• Stephen Michael Campbell, DO
• Tresa Campbell
• Melanie Camper, RN
• Cecilia Canale
• Caroline Jean Canavan
• Danielle Candela
• Steven Craig Candela, LMSW

• Clinical Psychologist in Detroit, MI
• Providers in Detroit, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.