Provider Demographics
NPI:1225657174
Name:CAMPBELL, MEAGHAN (LMHC)
Entity Type:Individual
Prefix:
First Name:MEAGHAN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:749 JASMINE WAY S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-4744
Mailing Address - Country:US
Mailing Address - Phone:407-342-3739
Mailing Address - Fax:
Practice Address - Street 1:749 JASMINE WAY S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-4744
Practice Address - Country:US
Practice Address - Phone:407-342-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15031101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty