MEDICARE: TALI'JA CAMPBELL MS, LPCC

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	LPCC.0019713	CO

General Provider Information

NPI Number	:	1942916754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALI'JA CAMPBELL MS, LPCC

Provider Business Mailing Address
First Line	:	9862 CHROMATIC TER
Second Line	:
City	:	PEYTON
State	:	CO
Zip	:	80831-6453
Country	:	US
Telephone Number	:	470-234-0266
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 N CASCADE AVE STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-3341
Country	:	US
Telephone Number	:	719-755-2158
Fax Number	:

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

Provider Enumeration Date	:	01/25/2023
Last Update Date	:	01/25/2023

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