Provider Demographics
NPI:1588814636
Name:CAMPBELL, TRACI LEIGH (LPC)
Entity Type:Individual
Prefix:
First Name:TRACI
Middle Name:LEIGH
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 NE 125TH ST STE 409
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5834
Mailing Address - Country:US
Mailing Address - Phone:888-852-6672
Mailing Address - Fax:877-720-0502
Practice Address - Street 1:6915 TUTT BLVD STE 110B
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3591
Practice Address - Country:US
Practice Address - Phone:719-445-1292
Practice Address - Fax:719-591-6486
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014308101YM0800X
KS1212103TC1900X
COPSY.0004952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPSY.0004952OtherLICENSE