Healthcare Provider Details

I. General information

NPI: 1457679136
Provider Name (Legal Business Name): LINDA L CALLAHAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA CALLAHAN

II. Dates (important events)

Enumeration Date: 05/05/2010
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 E FOOTHILL BLVD
PASADENA CA
91107-3148
US

IV. Provider business mailing address

967 E COLORADO BLVD # PO BOX 70253
PASADENA CA
91116
US

V. Phone/Fax

Practice location:
  • Phone: 626-840-2038
  • Fax:
Mailing address:
  • Phone: 626-822-9607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number60595
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number77473
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number60595
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: