Provider Demographics
NPI:1225356132
Name:CAMPBELL, PAUL (LMHC,LMT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LMHC,LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 NW 6TH ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-2234
Mailing Address - Country:US
Mailing Address - Phone:352-371-3718
Mailing Address - Fax:
Practice Address - Street 1:1409 NW 6TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-2234
Practice Address - Country:US
Practice Address - Phone:352-371-3718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH1644101YM0800X
FLMA3474225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1889OtherBLUE CROSS BLUE SHIELD PROVIDER NUMBER