Healthcare Provider Details

I. General information

NPI: 1699812743
Provider Name (Legal Business Name): DEVIN ARDELL CALLAHAN PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 CARMEL MTN RD STE D
SAN DIEGO CA
92129-2159
US

IV. Provider business mailing address

9320 CARMEL MTN RD STE D
SAN DIEGO CA
92129-2159
US

V. Phone/Fax

Practice location:
  • Phone: 619-899-0148
  • Fax: 858-484-5445
Mailing address:
  • Phone: 619-899-0148
  • Fax: 858-484-5445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: