Provider Demographics
NPI:1891520029
Name:CAMPBELL, AMY MAXWELL (MS LMFT-A)
Entity type:Individual
Prefix:MISS
First Name:AMY
Middle Name:MAXWELL
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:MS LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 BROADWAY BLVD STE 232
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2591
Mailing Address - Country:US
Mailing Address - Phone:469-969-0422
Mailing Address - Fax:
Practice Address - Street 1:3960 BROADWAY BLVD STE 232
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2591
Practice Address - Country:US
Practice Address - Phone:469-969-0422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205668101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health