Provider Demographics
NPI:1104387554
Name:CAMPBELL, VIRGINIA E (LMFT)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:E
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 N CAPITAL OF TEXAS HWY STE E240 UNIT #3250
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:254-244-2804
Mailing Address - Fax:
Practice Address - Street 1:3801 N CAPITAL OF TEXAS HWY STE E240 UNIT #3250
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-7318
Practice Address - Country:US
Practice Address - Phone:254-244-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT.0001554106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist