Provider Demographics
NPI:1497007645
Name:CAMPBELL, THOMAS A
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 W TROPICANA AVE
Mailing Address - Street 2:198
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4604
Mailing Address - Country:US
Mailing Address - Phone:702-205-3661
Mailing Address - Fax:
Practice Address - Street 1:6130 W TROPICANA AVE
Practice Address - Street 2:198
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89103-4604
Practice Address - Country:US
Practice Address - Phone:702-205-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV252400000X101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health