Provider Demographics
NPI:1457759821
Name:CAMPBELL BENNETT, PATRICIA (LPC)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:CAMPBELL BENNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 S LOGAN ST
Mailing Address - Street 2:#D-226
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3700
Mailing Address - Country:US
Mailing Address - Phone:720-519-8457
Mailing Address - Fax:
Practice Address - Street 1:1539 S BROADWAY
Practice Address - Street 2:BUILDING A
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2607
Practice Address - Country:US
Practice Address - Phone:730-519-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3133101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional