MEDICARE: MRS. JOY ROSE CAMPBELL 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	62784	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821236407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOY ROSE CAMPBELL LPC

Provider Business Mailing Address
First Line	:	107 FANNIN AVE
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5218
Country	:	US
Telephone Number	:	512-809-8679
Fax Number	:	512-285-4648

Provider Business Practice Location Address
First Line	:	107 FANNIN AVE
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-5218
Country	:	US
Telephone Number	:	512-809-8679
Fax Number	:	512-285-4648

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

Provider Enumeration Date	:	02/04/2009
Last Update Date	:	04/29/2016

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