Provider Demographics
NPI:1467491829
Name:NEW LIFE CHRISTIAN COUNSELING CENTER
Entity Type:Organization
Organization Name:NEW LIFE CHRISTIAN COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-322-6868
Mailing Address - Street 1:405 WAYMONT CT
Mailing Address - Street 2:STE. 111
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-3586
Mailing Address - Country:US
Mailing Address - Phone:407-322-6868
Mailing Address - Fax:407-322-6868
Practice Address - Street 1:405 WAYMONT CT
Practice Address - Street 2:STE. 111
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3586
Practice Address - Country:US
Practice Address - Phone:407-322-6868
Practice Address - Fax:407-322-6868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004142103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0005337111OtherAETNA PIN BRIAN CAMPBELL
1093863466OtherNPI BRIAN M CAMPBELL
FL73535OtherBLUE CROSS BLUE SHIELD
FL131134000OtherMAGELLAN - BRIAN CAMPBELL
FL053111OtherVALUOPTIONS-BRIANCAMPBELL
FL197423440OtherTRICARECHAMPUS
FL197423440OtherTRICARECHAMPUS