Provider Demographics
NPI:1386270106
Name:TELISHA CAMPBELL LCMHC PLLC
Entity type:Organization
Organization Name:TELISHA CAMPBELL LCMHC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TELISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:978-552-3141
Mailing Address - Street 1:10 ROSE FOUNTAIN LN
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:NH
Mailing Address - Zip Code:03842-3394
Mailing Address - Country:US
Mailing Address - Phone:978-552-3141
Mailing Address - Fax:877-894-5104
Practice Address - Street 1:10 ROSE FOUNTAIN LN
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:NH
Practice Address - Zip Code:03842-3394
Practice Address - Country:US
Practice Address - Phone:978-552-3141
Practice Address - Fax:877-894-5104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1004OtherLCMH LICENSE