Provider Demographics
NPI:1821236407
Name:CAMPBELL, JOY ROSE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JOY
Middle Name:ROSE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:JOY
Other - Middle Name:R
Other - Last Name:FELDKAMP-LEHTOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:107 FANNIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-5218
Mailing Address - Country:US
Mailing Address - Phone:512-809-8679
Mailing Address - Fax:512-285-4648
Practice Address - Street 1:107 FANNIN AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-5218
Practice Address - Country:US
Practice Address - Phone:512-809-8679
Practice Address - Fax:512-285-4648
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62784101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200730402Medicaid