Healthcare Provider Details

I. General information

NPI: 1275625436
Provider Name (Legal Business Name): MCCALLUM GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W. LOCKWOOD AVE #201
ST. LOUIS MO
63119
US

IV. Provider business mailing address

4020 ASPEN GROVE DR STE 900
FRANKLIN TN
37067-3134
US

V. Phone/Fax

Practice location:
  • Phone: 314-968-1900
  • Fax: 314-968-1901
Mailing address:
  • Phone: 615-861-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number5707-8806
License Number StateMO

VIII. Authorized Official

Name: BRIAN P FARLEY
Title or Position: VICE PRESIDENT AND SECRETARY
Credential:
Phone: 615-861-6000