MEDICARE: CAMILLE ANNE CAMPBELL L.P.C.

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	1504	LA

General Provider Information

NPI Number	:	1609071638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE ANNE CAMPBELL L.P.C.

Provider Business Mailing Address
First Line	:	7027 MILNE BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-2341
Country	:	US
Telephone Number	:	504-288-7762
Fax Number	:	504-288-7629

Provider Business Practice Location Address
First Line	:	7027 MILNE BLVD
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70124-2341
Country	:	US
Telephone Number	:	504-288-7762
Fax Number	:	504-288-7629

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	07/08/2007

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