Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 30838 | TX |
NPI | 1003028713 |
---|---|
Provider Name | Miss Catherine Phelps Campbell |
First Address | Waco, TX 76712-3991 |
Second Address | Waco, TX 76712-3991 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1767154 | (05) | TX |