Provider Demographics
NPI:1790448942
Name:CAMPANELLA, BLAISE CHANSE (MFTC)
Entity type:Individual
Prefix:
First Name:BLAISE
Middle Name:CHANSE
Last Name:CAMPANELLA
Suffix:
Gender:M
Credentials:MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 W MAIN ST STE 170
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-4612
Mailing Address - Country:US
Mailing Address - Phone:303-501-9436
Mailing Address - Fax:
Practice Address - Street 1:2629 W MAIN ST STE 170
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-4612
Practice Address - Country:US
Practice Address - Phone:303-501-9436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0002382106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist