Provider Demographics
NPI:1295965382
Name:CAMPBELL, LEISHA NICOLE (MED, LPC, BEI-II)
Entity type:Individual
Prefix:
First Name:LEISHA
Middle Name:NICOLE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MED, LPC, BEI-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 MONTERRA PT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-2027
Mailing Address - Country:US
Mailing Address - Phone:281-451-1171
Mailing Address - Fax:
Practice Address - Street 1:3701 KIRBY DR
Practice Address - Street 2:SUITE 1014
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3900
Practice Address - Country:US
Practice Address - Phone:281-451-1171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX60525101YM0800X
TX846040101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool