1346323730 NPI number — LISA MICHELLE CALLOWAY LCSW

Table of content: LISA MICHELLE CALLOWAY LCSW (NPI 1346323730)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346323730 NPI number — LISA MICHELLE CALLOWAY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALLOWAY
Provider First Name:
LISA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346323730
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 428247
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERGREEN PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60805-8247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-272-6240
Provider Business Mailing Address Fax Number:
630-364-2555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9748 S ROBERTS RD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALOS HILLS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60465-1495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-866-0315
Provider Business Practice Location Address Fax Number:
630-596-4549
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  149.009437 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 218668127 . This is a "UNITED BEHAVIORAL HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 293092 . This is a "INDIVIDUAL # FOR MHN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 311641 . This is a "GROUP # FOR MHN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 449000 . This is a "PROVIDER # FOR PSYCHEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 409970/57007900 . This is a "PROVIDER # FOR MAGELLAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 0001633386 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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