Healthcare Provider Details

I. General information

NPI: 1588508360
Provider Name (Legal Business Name): CALLAN BARRETT LICSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 GRANDVIEW DR
CHAMPAIGN IL
61820-6824
US

IV. Provider business mailing address

1321 GRANDVIEW DR
CHAMPAIGN IL
61820-6824
US

V. Phone/Fax

Practice location:
  • Phone: 217-688-1357
  • Fax: 217-771-1656
Mailing address:
  • Phone: 217-688-1357
  • Fax: 217-771-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: CALLAN BARRETT
Title or Position: OWNER
Credential: LICSW
Phone: 217-688-1357