Provider Demographics
NPI:1932540663
Name:CAMPOS, JULISSA (LMHC-D, NCC, CASAC)
Entity type:Individual
Prefix:MS
First Name:JULISSA
Middle Name:
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LMHC-D, NCC, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 PLANK RD STE 111
Mailing Address - Street 2:
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4886
Mailing Address - Country:US
Mailing Address - Phone:347-251-2834
Mailing Address - Fax:929-322-9200
Practice Address - Street 1:636 PLANK RD STE 111
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4886
Practice Address - Country:US
Practice Address - Phone:347-251-2834
Practice Address - Fax:929-322-9200
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29180101YA0400X
NY006711101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)