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General NPI Number Information
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NPI Number | 1871762781
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Entity Type | Individual
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Provider Name | CALLIE JUNG ONEESE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 02/25/2008
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 3960 PATIENT CARE WAY STE 104
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City | LANSING
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State | MI
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Zip | 48911-4275
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Country | US
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Telephone | 517-887-9801
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Fax | 517-887-9826
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Provider Business Mailing Address
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Address Line | 3420 DAWSON LOOP DAWSON LOOP
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City | FORT BENNING
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State | GA
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Zip | 31905
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Country | US
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Telephone |
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 630015203
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301015203
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License Number State | MI
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