Healthcare Provider Details

I. General information

NPI: 1245166743
Provider Name (Legal Business Name): CLARISSA CALLAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 W 16TH ST STE 6
YUMA AZ
85364-4424
US

IV. Provider business mailing address

2909 W 20TH PL
YUMA AZ
85364-6009
US

V. Phone/Fax

Practice location:
  • Phone: 928-247-9602
  • Fax:
Mailing address:
  • Phone: 928-581-8493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: