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General NPI Number Information
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NPI Number | 1730909151
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Entity Type | Individual
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Provider Name | NATHAN CALLAGHAN
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Gender | Male
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Dates
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Enumeration Date | 10/10/2024
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Last Update Date | 10/10/2024
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Provider Practice Location Address
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Address Line | 3250 UNIVERSITY DR STE 115
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City | AUBURN HILLS
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State | MI
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Zip | 48326-2391
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Country | US
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Telephone | 248-844-2647
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Fax |
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Provider Business Mailing Address
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Address Line | 248 W AUBURN TRL
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City | BRIGHTON
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State | MI
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Zip | 48114-5001
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Country | US
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Telephone | 810-623-5065
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6362009771
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6451023165
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License Number State | MI
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