Healthcare Provider Details

I. General information

NPI: 1104303544
Provider Name (Legal Business Name): MARCA MCCALLIE PHD, PSY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 E ROUTE 66 STE 203
FLAGSTAFF AZ
86001-5777
US

IV. Provider business mailing address

16 E ROUTE 66 STE 203
FLAGSTAFF AZ
86001-5777
US

V. Phone/Fax

Practice location:
  • Phone: 928-606-2907
  • Fax: 928-864-5024
Mailing address:
  • Phone: 928-606-2907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPSY-005968
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number005968
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: