Healthcare Provider Details

I. General information

NPI: 1932648359
Provider Name (Legal Business Name): MICHELLE J.G. PERIN-CALLAHAN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2017
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 E 12TH AVE
EUGENE OR
97401-3212
US

IV. Provider business mailing address

37875 JASPER LOWELL RD.
JASPER OR
97438
US

V. Phone/Fax

Practice location:
  • Phone: 541-342-8255
  • Fax:
Mailing address:
  • Phone: 541-747-1235
  • Fax: 541-747-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number144476
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: