Provider Demographics
NPI:1619216629
Name:CAMPBELL, KATE M (PHD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:KATE
Middle Name:M
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 E COMMERCIAL BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4034
Mailing Address - Country:US
Mailing Address - Phone:954-391-5305
Mailing Address - Fax:954-634-5360
Practice Address - Street 1:2425 E COMMERCIAL BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4034
Practice Address - Country:US
Practice Address - Phone:954-391-5305
Practice Address - Fax:954-634-5360
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-11
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2369106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist