Provider Demographics
NPI:1437615564
Name:CAMPBELL, TROY (LCSW)
Entity type:Individual
Prefix:MR
First Name:TROY
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1631
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-1631
Mailing Address - Country:US
Mailing Address - Phone:505-709-0608
Mailing Address - Fax:
Practice Address - Street 1:346 EAGLE DR
Practice Address - Street 2:
Practice Address - City:OHKAY OWINGEH
Practice Address - State:NM
Practice Address - Zip Code:87566-3600
Practice Address - Country:US
Practice Address - Phone:505-901-8725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-12090101YA0400X, 101YM0800X, 1041C0700X, 101YM0800X
373H00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1437615564Medicaid