Healthcare Provider Details

I. General information

NPI: 1437615564
Provider Name (Legal Business Name): TROY CAMPBELL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2019
Last Update Date: 06/11/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

346 EAGLE DR
OHKAY OWINGEH NM
87566-3600
US

IV. Provider business mailing address

PO BOX 1631
ESPANOLA NM
87532-1631
US

V. Phone/Fax

Practice location:
  • Phone: 505-901-8725
  • Fax:
Mailing address:
  • Phone: 505-709-0608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-12090
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC-12090
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-12090
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: