Healthcare Provider Details

I. General information

NPI: 1205355963
Provider Name (Legal Business Name): SHELBI RAYLENE CALLAHAN ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10201 MISSION GORGE RD STE O
SANTEE CA
92071-3027
US

IV. Provider business mailing address

5757 LAKE MURRAY BLVD APT 142
LA MESA CA
91942-2202
US

V. Phone/Fax

Practice location:
  • Phone: 619-383-6868
  • Fax: 619-312-2661
Mailing address:
  • Phone: 661-809-4399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW71912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: