Provider Demographics
NPI:1568935385
Name:CAMPAGNA, HENRY JOSEPH (LMFT)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:JOSEPH
Last Name:CAMPAGNA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 EUCALYPTUS AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-4605
Mailing Address - Country:US
Mailing Address - Phone:626-274-1589
Mailing Address - Fax:
Practice Address - Street 1:121 LINDEN AVE STE B103
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4990
Practice Address - Country:US
Practice Address - Phone:626-274-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100285106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist