Healthcare Provider Details

I. General information

NPI: 1457435018
Provider Name (Legal Business Name): JANET CALLAHAN, APRN, BC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 N 7TH ST SUITE B-104
PHOENIX AZ
85022-4382
US

IV. Provider business mailing address

14001 N 7TH ST SUITE B-104
PHOENIX AZ
85022-4382
US

V. Phone/Fax

Practice location:
  • Phone: 602-993-2959
  • Fax: 602-548-5881
Mailing address:
  • Phone: 602-993-2959
  • Fax: 602-548-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberRN038048
License Number StateAZ

VIII. Authorized Official

Name: JANET CALLAHAN
Title or Position: MANAGING MEMBER
Credential: RN, APRN, BC
Phone: 602-993-2959