Provider Demographics
NPI:1942581921
Name:CAMPBELL, KAREN R (PED)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:R
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 RANCH ESTATES
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074
Mailing Address - Country:US
Mailing Address - Phone:469-525-1935
Mailing Address - Fax:
Practice Address - Street 1:10503 METRIC DRIVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243
Practice Address - Country:US
Practice Address - Phone:972-644-2076
Practice Address - Fax:972-644-5650
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX#23150103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist