MEDICARE: ANNIE CAMPANARO LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	3976	CO

General Provider Information

NPI Number	:	1013071703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNIE CAMPANARO LPC

Provider Business Mailing Address
First Line	:	PO BOX 60852
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80960-0852
Country	:	US
Telephone Number	:	719-578-9445
Fax Number	:

Provider Business Practice Location Address
First Line	:	755 HIGHWAY 105
Second Line	:	SUITE 2-E
City	:	PALMER LAKE
State	:	CO
Zip	:	80133-9039
Country	:	US
Telephone Number	:	719-358-1010
Fax Number	:	717-578-9445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	12/07/2016

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Directions to “ ANNIE CAMPANARO LPC” Practice Location

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