MEDICARE: MCCALL ELIZABETH CAMPBELL LPC

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

General Provider Information

NPI Number	:	1265038467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCCALL ELIZABETH CAMPBELL LPC

Provider Business Mailing Address
First Line	:	9744 E TWINKLE AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-2190
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	301 E BETHANY HOME RD STE C188
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85012-1295
Country	:	US
Telephone Number	:	480-389-6933
Fax Number	:

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

Provider Enumeration Date	:	12/11/2020
Last Update Date	:	03/22/2022

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