Healthcare Provider Details

I. General information

NPI: 1306243068
Provider Name (Legal Business Name): NANCY A CALLOWAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 SAN PEDRO DR NE SUITE 203
ALBUQUERQUE NM
87110-4131
US

IV. Provider business mailing address

1620 RANCH CT SE
ALBUQUERQUE NM
87123-4476
US

V. Phone/Fax

Practice location:
  • Phone: 505-414-7721
  • Fax:
Mailing address:
  • Phone: 505-239-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0826
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number248137
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: