Healthcare Provider Details

I. General information

NPI: 1780906206
Provider Name (Legal Business Name): KELLEY CALLAHAN PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2010
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 E MAIN ST
GREENVILLE OH
45331-1913
US

IV. Provider business mailing address

PO BOX 895 212 EAST MAIN STREET
GREENVILLE OH
45331
US

V. Phone/Fax

Practice location:
  • Phone: 937-548-1635
  • Fax: 937-548-1500
Mailing address:
  • Phone: 937-548-1635
  • Fax: 937-548-1500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: