MEDICARE: BREE CALLAHAM 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
1	106H00000X	Marriage & Family Therapist	MFC82207	CA

General Provider Information

NPI Number	:	1972076222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREE CALLAHAM MFT

Provider Business Mailing Address
First Line	:	8424 SANTA MONICA BLVD # A103
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-6233
Country	:	US
Telephone Number	:	310-970-2097
Fax Number	:

Provider Business Practice Location Address
First Line	:	8702 SANTA MONICA BLVD
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-4508
Country	:	US
Telephone Number	:	310-970-2097
Fax Number	:

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

Provider Enumeration Date	:	01/09/2019
Last Update Date	:	01/09/2019

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