Provider Demographics
NPI:1134368251
Name:CAMPOS, ADAM SAMUEL (LPC)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:SAMUEL
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6418 VILLAGE PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-4030
Mailing Address - Country:US
Mailing Address - Phone:210-436-2339
Mailing Address - Fax:210-436-2329
Practice Address - Street 1:803 CASTROVILLE RD
Practice Address - Street 2:413
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78237-3153
Practice Address - Country:US
Practice Address - Phone:210-436-2339
Practice Address - Fax:210-436-2329
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional