Provider Demographics
NPI:1003028713
Name:CAMPBELL, CATHERINE PHELPS (LCSW)
Entity type:Individual
Prefix:MISS
First Name:CATHERINE
Middle Name:PHELPS
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7030 NEW SANGER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3991
Mailing Address - Country:US
Mailing Address - Phone:254-399-9540
Mailing Address - Fax:254-753-5225
Practice Address - Street 1:400 N ALLEN DR STE 204
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2568
Practice Address - Country:US
Practice Address - Phone:972-233-1010
Practice Address - Fax:214-623-6692
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX308381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1767154Medicaid
TX612124Medicare ID - Type Unspecified