MEDICARE: CYDNEY DIANE CAMPBELL MA, LMHC, NCC

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	0082521	NM

General Provider Information

NPI Number	:	1215267893
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYDNEY DIANE CAMPBELL MA, LMHC, NCC

Provider Business Mailing Address
First Line	:	4995 ARROYO CHAMISA RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87111-3719
Country	:	US
Telephone Number	:	505-271-6465
Fax Number	:	505-271-6465

Provider Business Practice Location Address
First Line	:	7001 PROSPECT PL NE
Second Line	:	SUITE A
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4311
Country	:	US
Telephone Number	:	505-823-4530
Fax Number	:

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

Provider Enumeration Date	:	01/05/2010
Last Update Date	:	01/05/2010

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