Provider Demographics
NPI:1508121872
Name:CAMPBELL, LAUREN (MA, LPC, LMFT-A)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MA, LPC, LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 S ROCK ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5837
Mailing Address - Country:US
Mailing Address - Phone:512-843-2722
Mailing Address - Fax:
Practice Address - Street 1:1006 S ROCK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5837
Practice Address - Country:US
Practice Address - Phone:512-843-2722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63902101YP2500X
TX201231106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist