MEDICARE: RENEE CAMPBELL MA, LPC-ASSOCIATE

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	82278	TX

General Provider Information

NPI Number	:	1922875483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE CAMPBELL MA, LPC-ASSOCIATE

Provider Business Mailing Address
First Line	:	104 E HIGHLAND MALL BLVD STE 115
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78752-3775
Country	:	US
Telephone Number	:	512-961-5575
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 E HIGHLAND MALL BLVD STE 115
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78752-3775
Country	:	US
Telephone Number	:	512-961-5575
Fax Number	:

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

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	12/05/2023

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