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NPI Code Detail

MEDICARE: MR. HENRY MATT CALLIHAN III LADAC

MEDICARE: MR. HENRY MATT CALLIHAN III LADAC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) CounselorLDC0000000084TN

General Provider Information

NPI Number : 1306050349
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. HENRY MATT CALLIHAN III LADAC
Provider Business Mailing Address
First Line : 2200 MORRIS HILL RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-2818
Country : US
Telephone Number : 423-894-4220
Fax Number : 423-499-2320
Provider Business Practice Location Address
First Line : 2200 MORRIS HILL RD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-2818
Country : US
Telephone Number : 423-894-4220
Fax Number : 423-499-2320
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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