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NPI Code Detail

MEDICARE: RANDALL CALLAWAY M.S., MFT

MEDICARE: RANDALL CALLAWAY M.S., MFT
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
1101YM0800XMental Health Counselor
2106H00000XMarriage & Family Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346679685
Entity Type Code : Individual
Provider Name (Legal Business Name) : RANDALL CALLAWAY M.S., MFT
Provider Business Mailing Address
First Line : 5584 S FORT APACHE RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-7657
Country : US
Telephone Number : 702-743-3305
Fax Number :
Provider Business Practice Location Address
First Line : 5584 S FORT APACHE RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-7657
Country : US
Telephone Number : 702-743-3305
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/07/2013
Last Update Date : 01/26/2024

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