Provider Demographics
NPI:1942729397
Name:CAMPBELL, CHRISTA JACQUELINE (LMFT, LPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTA
Middle Name:JACQUELINE
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2804 GARDEN PL
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3804
Mailing Address - Country:US
Mailing Address - Phone:479-310-0755
Mailing Address - Fax:
Practice Address - Street 1:910 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4565
Practice Address - Country:US
Practice Address - Phone:479-310-0755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARM1709029106H00000X
ARP1709350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist