Provider Demographics
NPI:1154039063
Name:CAMPOS, DERLING (LCSW)
Entity type:Individual
Prefix:
First Name:DERLING
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:DERLING
Other - Middle Name:R
Other - Last Name:CAMPOS MARTINEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1800 N BRITAIN RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1800 N BRITAIN RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2630
Practice Address - Country:US
Practice Address - Phone:214-266-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-09
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX648921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical