Provider Demographics
NPI:1245107275
Name:CORPORATE COMEDY LIVE
Entity type:Organization
Organization Name:CORPORATE COMEDY LIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF THERAPY OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTOR OF MINISTRY
Authorized Official - Phone:346-740-4814
Mailing Address - Street 1:3303 CYPRESS CREEK PKWY STE 380
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-9909
Mailing Address - Country:US
Mailing Address - Phone:346-740-4814
Mailing Address - Fax:
Practice Address - Street 1:3303 CYPRESS CREEK PKWY STE 380
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-9909
Practice Address - Country:US
Practice Address - Phone:346-740-4814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-23
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty