Provider Demographics
NPI:1083629653
Name:CAMPBELL BEHAVIORAL SERVICE INC
Entity Type:Organization
Organization Name:CAMPBELL BEHAVIORAL SERVICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-532-9050
Mailing Address - Street 1:1300G EL PASEO RD # 135
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-6024
Mailing Address - Country:US
Mailing Address - Phone:505-532-9050
Mailing Address - Fax:505-522-3689
Practice Address - Street 1:506 S MAIN ST
Practice Address - Street 2:SUITE 420
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1207
Practice Address - Country:US
Practice Address - Phone:505-532-9050
Practice Address - Fax:505-522-3689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM50621319Medicaid