MEDICARE: CATHERINE CALLENDER LLC

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	104100000X	Social Worker	C3503	MS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1174652523	OTHER	MS	MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1851668131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHERINE CALLENDER LLC

Provider Business Mailing Address
First Line	:	134 FAIRMONT ST
Second Line	:	STE E
City	:	CLINTON
State	:	MS
Zip	:	39056-4739
Country	:	US
Telephone Number	:	601-925-8194
Fax Number	:	601-925-8196

Provider Business Practice Location Address
First Line	:	134 FAIRMONT ST
Second Line	:	STE E
City	:	CLINTON
State	:	MS
Zip	:	39056-4739
Country	:	US
Telephone Number	:	601-925-8194
Fax Number	:	601-925-8196

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. CATHERINE CALLENDER
Credential	:	LCSW
Telephone Number	:	601-925-8194

Provider Enumeration Date	:	11/30/2011
Last Update Date	:	11/30/2011

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Directions to “CATHERINE CALLENDER LLC ” Practice Location

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