Provider Demographics
NPI:1962963793
Name:CAMPBELL, WILLIAM RUSSELL (LPC)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RUSSELL
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5834 WESTSLOPE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3633
Mailing Address - Country:US
Mailing Address - Phone:512-925-7033
Mailing Address - Fax:
Practice Address - Street 1:607 RATHERVUE PL
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-3127
Practice Address - Country:US
Practice Address - Phone:512-469-9447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-26
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74707101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor