MEDICARE: STEPHANIE CAMPBELL LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH15625	FL

General Provider Information

NPI Number	:	1053808204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE CAMPBELL LMHC

Provider Business Mailing Address
First Line	:	13801 WALSINGHAM RD UNIT 127
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-3237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13801 WALSINGHAM RD UNIT 127
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33774-3237
Country	:	US
Telephone Number	:	727-470-8003
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2018
Last Update Date	:	04/13/2018

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