Provider Demographics
NPI:1003054792
Name:CAMPBELL, CHERYL EDWARDS (LCSW; LSOTP, CSAT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:EDWARDS
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW; LSOTP, CSAT
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 484
Mailing Address - Street 2:
Mailing Address - City:ARGYLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-0484
Mailing Address - Country:US
Mailing Address - Phone:940-783-5592
Mailing Address - Fax:
Practice Address - Street 1:914 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2954
Practice Address - Country:US
Practice Address - Phone:940-387-6250
Practice Address - Fax:940-387-6274
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-03
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX99155101Y00000X
AZCSAT 2002C-0125101Y00000X
TX60241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor