1457642720 NPI number — MRS. MELISSA ANNETTE CAMPOS LMHC

Table of content: MRS. MELISSA ANNETTE CAMPOS LMHC (NPI 1457642720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457642720 NPI number — MRS. MELISSA ANNETTE CAMPOS LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAMPOS
Provider First Name:
MELISSA
Provider Middle Name:
ANNETTE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC
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:
1457642720
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4425 MILITARY TRL
Provider Second Line Business Mailing Address:
#203
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458-4819
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-747-2775
Provider Business Mailing Address Fax Number:
561-747-1881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4425 MILITARY TRL
Provider Second Line Business Practice Location Address:
#203
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-4819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-747-2775
Provider Business Practice Location Address Fax Number:
561-747-1881
Provider Enumeration Date:
04/21/2011

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: MH9360 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002147800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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