Provider Demographics
NPI:1023439148
Name:CAMPBELL, WENDY (LCSW)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 CASE ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-3605
Mailing Address - Country:US
Mailing Address - Phone:713-906-9717
Mailing Address - Fax:
Practice Address - Street 1:2421 TANGLEY ST
Practice Address - Street 2:SUITE 117
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2517
Practice Address - Country:US
Practice Address - Phone:713-380-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-16
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX538581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical