Provider Demographics
NPI:1437615564
Name:CAMPBELL, TROY (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TROY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2212
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2212
Mailing Address - Country:US
Mailing Address - Phone:505-709-0608
Mailing Address - Fax:
Practice Address - Street 1:145 CALLE DEL PRESIDENTE UNIT 382
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-2016
Practice Address - Country:US
Practice Address - Phone:505-709-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-12090101YA0400X, 101YM0800X
171400000X, 332U00000X, 373H00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171400000XOther Service ProvidersHealth & Wellness CoachGroup - Multi-Specialty
No332U00000XSuppliersHome Delivered Meals
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1437615564Medicaid