Provider Demographics
NPI:1497884688
Name:MICHAEL E. CAMPBELL, PH.D., P.A.
Entity Type:Organization
Organization Name:MICHAEL E. CAMPBELL, PH.D., P.A.
Other - Org Name:MICHAEL E. CAMPBELL, PH.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:254-690-1512
Mailing Address - Street 1:880 PROSPECTOR TRAIL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548
Mailing Address - Country:US
Mailing Address - Phone:254-690-1512
Mailing Address - Fax:
Practice Address - Street 1:880 PROSPECTOR TRAIL
Practice Address - Street 2:SUITE 100
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548
Practice Address - Country:US
Practice Address - Phone:254-690-1512
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-1603103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00W111Medicare ID - Type Unspecified