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General NPI Number Information
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NPI Number | 1619244571
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Entity Type | Individual
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Provider Name | JORDAN ALLEN CALLOWAY PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 853 STATE ROAD 436 STE 2045
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City | CASSELBERRY
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State | FL
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Zip | 32707-5480
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Country | US
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Telephone | 407-598-0202
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Fax |
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Provider Business Mailing Address
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Address Line | 116 TUSCANY BEND ST
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5545
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Country | US
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Telephone | 386-479-7714
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY10485
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License Number State | FL
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