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General NPI Number Information
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NPI Number | 1891075651
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Entity Type | Organization
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Legal Business Name | BRIDGET M. CALLAGHAN, LCSW, LLC
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Dates
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Enumeration Date | 08/25/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 3537 W FRONT ST STE F
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7943
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Country | US
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Telephone | 231-935-8900
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Fax | 231-935-8901
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Provider Business Mailing Address
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Address Line | 3537 W FRONT ST STE F
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City | TRAVERSE CITY
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State | MI
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Zip | 49684-7943
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Country | US
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Telephone | 231-935-8900
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Fax | 231-935-8901
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Authorized Official
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Title or Position | MANGER
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Name | MRS. BRIDGET MAUREEN CALLAGHAN
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Credential | LCSW
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Telephone | 231-935-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6801087127
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License Number State | MI
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