Healthcare Provider Details

I. General information

NPI: 1366288698
Provider Name (Legal Business Name): MACKENZIE CALLAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2024
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 N MAIN ST STE 220
CHELSEA MI
48118-1635
US

IV. Provider business mailing address

13098 SPECKLEDWOOD DR
DEWITT MI
48820-8191
US

V. Phone/Fax

Practice location:
  • Phone: 734-433-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6301019746
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: