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General NPI Number Information
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NPI Number | 1720865793
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Entity Type | Individual
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Provider Name | TATIANA D CAMPBELL LPC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 5908 GETWELL RD
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City | SOUTHAVEN
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State | MS
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Zip | 38672-7317
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Country | US
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Telephone | 662-536-4646
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Fax | 662-536-4443
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Provider Business Mailing Address
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Address Line | 1211 UNION AVE STE 330
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City | MEMPHIS
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State | TN
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Zip | 38104-6655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701012355
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3056
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License Number State | MS
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