Healthcare Provider Details

I. General information

NPI: 1811638836
Provider Name (Legal Business Name): CALLIE GILCHREST PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S VAL VISTA DR BLDG 4
GILBERT AZ
85295-1675
US

IV. Provider business mailing address

711 41ST AVE NE
ST PETERSBURG FL
33703-5101
US

V. Phone/Fax

Practice location:
  • Phone: 512-615-5186
  • Fax:
Mailing address:
  • Phone: 954-292-9363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number11371
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: