1295965382 NPI number — LEISHA NICOLE CAMPBELL M.ED., LPC, BEI-II

Table of content: LEISHA NICOLE CAMPBELL M.ED., LPC, BEI-II (NPI 1295965382)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295965382 NPI number — LEISHA NICOLE CAMPBELL M.ED., LPC, BEI-II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPBELL
Provider First Name:
LEISHA
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPC, BEI-II
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295965382
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1427 MONTERRA PT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRESNO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77545-2027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-451-1171
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3701 KIRBY DR
Provider Second Line Business Practice Location Address:
SUITE 1014
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77098-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-451-1171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  60525 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YS0200X , with the licence number: 846040 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com