Healthcare Provider Details

I. General information

NPI: 1407845233
Provider Name (Legal Business Name): THOMAS WILLIAM CALLAHAN MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10220 N 31ST AVE SUITE 205
PHOENIX AZ
85051-9581
US

IV. Provider business mailing address

10220 N 31ST AVE SUITE 205
PHOENIX AZ
85051-9581
US

V. Phone/Fax

Practice location:
  • Phone: 602-997-1515
  • Fax: 602-997-1305
Mailing address:
  • Phone: 602-997-1515
  • Fax: 602-997-1305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW0161
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: