1609986496 NPI number — DR. BETSY NICHOLSON CALLAHAN DSW LCSW

Table of content: DR. BETSY NICHOLSON CALLAHAN DSW LCSW (NPI 1609986496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609986496 NPI number — DR. BETSY NICHOLSON CALLAHAN DSW LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CALLAHAN
Provider First Name:
BETSY
Provider Middle Name:
NICHOLSON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DSW LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NICHOLSON
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609986496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1782 E HOLLADAY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84124-2606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-272-3584
Provider Business Mailing Address Fax Number:
801-272-3584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LIFESKILLS SUPPORT CTR
Provider Second Line Business Practice Location Address:
HILL AIR FORCE BASE
Provider Business Practice Location Address City Name:
HILL AFB
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-777-7909
Provider Business Practice Location Address Fax Number:
801-777-4490
Provider Enumeration Date:
08/30/2006

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:  1314123501 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1314123501 . This is a "LCSW DIV OF OCC. PROF LIC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com