=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902663016
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KRISTEN ELIZABETH CAMPBELL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2024
-----------------------------------------------------
Last Update Date | 10/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 107 S DALLAS ST
-----------------------------------------------------
City | ENNIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75119-4786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 430-236-2552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 519 WATERBOARD DR
-----------------------------------------------------
City | TRINIDAD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75163-9606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 430-236-2552
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 88927
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------