MEDICARE: ANGELA RENEE CAMPOS LPC-MHSP

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	101YP2500X	Professional Counselor	8034	TN

General Provider Information

NPI Number	:	1205706694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA RENEE CAMPOS LPC-MHSP

Provider Business Mailing Address
First Line	:	8283 RIVER ROAD PIKE
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37209-6009
Country	:	US
Telephone Number	:	615-690-4514
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 DUNBAR CAVE RD STE B
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-8844
Country	:	US
Telephone Number	:	615-690-4514
Fax Number	:

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

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	11/10/2025

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