MEDICARE: MS. JEAN RONELLE CALLIHAN LMFT, LISAC

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
1	106H00000X	Marriage & Family Therapist	LMFT10226	AZ
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	LISAC-10760	AZ

Other Identifiers

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

General Provider Information

NPI Number	:	1740344993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JEAN RONELLE CALLIHAN LMFT, LISAC

Provider Business Mailing Address
First Line	:	2500 E SHOW LOW LAKE RD
Second Line	:
City	:	SHOW LOW
State	:	AZ
Zip	:	85901-7929
Country	:	US
Telephone Number	:	928-537-2951
Fax Number	:	928-537-4841

Provider Business Practice Location Address
First Line	:	2500 E SHOW LOW LAKE RD
Second Line	:
City	:	SHOW LOW
State	:	AZ
Zip	:	85901-7929
Country	:	US
Telephone Number	:	928-537-2951
Fax Number	:	928-537-4841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	09/25/2009

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