=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235076977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PTSD AWARENESS SUMMIT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2026
-----------------------------------------------------
Last Update Date | 04/30/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10910 ANGUS LN
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33905-6707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-699-6732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10910 ANGUS LN
-----------------------------------------------------
City | FORT MYERS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33905-6707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-699-6732
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | KEITH JOSEPH CAMPBELL
-----------------------------------------------------
Credential | CAMPBELL
-----------------------------------------------------
Telephone | 239-699-6732
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225800000X
-----------------------------------------------------
Taxonomy Name | Recreation Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------