Healthcare Provider Details

I. General information

NPI: 1215267893
Provider Name (Legal Business Name): CYDNEY DIANE CAMPBELL MA, LMHC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2010
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 PROSPECT PL NE SUITE A
ALBUQUERQUE NM
87110-4311
US

IV. Provider business mailing address

4995 ARROYO CHAMISA RD NE
ALBUQUERQUE NM
87111-3719
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-4530
  • Fax:
Mailing address:
  • Phone: 505-271-6465
  • Fax: 505-271-6465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0082521
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: