Provider Demographics
NPI:1942916754
Name:CAMPBELL, TALI'JA (MS, LPCC)
Entity Type:Individual
Prefix:
First Name:TALI'JA
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9862 CHROMATIC TER
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-6453
Mailing Address - Country:US
Mailing Address - Phone:470-234-0266
Mailing Address - Fax:
Practice Address - Street 1:525 N CASCADE AVE STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3341
Practice Address - Country:US
Practice Address - Phone:719-755-2158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0019713101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional