Provider Demographics
NPI:1073661781
Name:CAMPBELL, CARRIE KATHLEEN (LPC)
Entity Type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:KATHLEEN
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 HOT SHOT LN
Mailing Address - Street 2:
Mailing Address - City:MCQUEENEY
Mailing Address - State:TX
Mailing Address - Zip Code:78123-3508
Mailing Address - Country:US
Mailing Address - Phone:830-822-1756
Mailing Address - Fax:
Practice Address - Street 1:640 HOT SHOT LN
Practice Address - Street 2:
Practice Address - City:MCQUEENEY
Practice Address - State:TX
Practice Address - Zip Code:78123-3508
Practice Address - Country:US
Practice Address - Phone:830-822-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16045101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional