Provider Demographics
NPI:1235216540
Name:CAMPBELL, MARY ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
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 1:1702 E HIGHLAND AVE
Mailing Address - Street 2:SUITE 318
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4664
Mailing Address - Country:US
Mailing Address - Phone:602-604-9440
Mailing Address - Fax:602-604-9600
Practice Address - Street 1:1702 E HIGHLAND AVE
Practice Address - Street 2:SUITE 318
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-4664
Practice Address - Country:US
Practice Address - Phone:602-604-9440
Practice Address - Fax:602-604-9600
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC12444101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional