NPIMap

Organization Active NPI

New Life Christian Counseling Center

  • Clinical Psychologist
  • Lake Mary, FL
National Provider Identifier
1467491829
Registry record updated Oct 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY0004142 Issued in FL
Legal business name
NEW LIFE CHRISTIAN COUNSELING CENTER
Practice address
405 Waymont CT
Ste. 111
Lake Mary, FL 32746-3586
Phone
(407) 322-6868
Fax
(407) 322-6868
NPI assigned
Jun 4, 2006
Last updated
Oct 27, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Brian Matthew Campbell, PH.D.NPI 1093863466
Title
President
Phone
(407) 322-6868

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY0004142 FL Primary

Addresses

Primary practice location

405 Waymont CT
Ste. 111
Lake Mary, FL 32746-3586

Mailing address

405 Waymont CT
Ste. 111
Lake Mary, FL 32746-3586
Phone (407) 322-6868

Other identifiers 6

IdentifierTypeStateIssuer
197423440OtherFLTRICARECHAMPUS
73535OtherFLBLUE CROSS BLUE SHIELD
131134000OtherFLMAGELLAN - BRIAN CAMPBELL
0005337111OtherFLAETNA PIN BRIAN CAMPBELL
053111OtherFLVALUOPTIONS-BRIANCAMPBELL
1093863466OtherNPI BRIAN M CAMPBELL

National Provider Directory

National Provider Directory

Locations

405 Waymont Ct
Ste 111
Lake Mary, FL 32746
Phone (407) 322-6868

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288137600000",
    "number": "1467491829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 WAYMONT CT",
            "address_2": "STE. 111",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463586",
            "telephone_number": "407-322-6868",
            "fax_number": "407-322-6868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 WAYMONT CT",
            "address_2": "STE. 111",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463586",
            "telephone_number": "407-322-6868",
            "fax_number": "407-322-6868"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW LIFE CHRISTIAN COUNSELING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-04",
        "last_updated": "2010-10-27",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-322-6868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY0004142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARECHAMPUS",
            "identifier": "197423440",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "73535",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN - BRIAN CAMPBELL",
            "identifier": "131134000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN BRIAN CAMPBELL",
            "identifier": "0005337111",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUOPTIONS-BRIANCAMPBELL",
            "identifier": "053111",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI BRIAN M CAMPBELL",
            "identifier": "1093863466",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.