Basic Information
| Provider Information | |||||||||
| NPI: | 1063789808 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCALLISTER | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | RICK | ||||||||
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| Credential: | LICENSED CLINICAL AD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 W. MILLS ST., PO BOX 130 | ||||||||
| Address2: | POLK WELLNESS CENTER | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 28722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288942222 | ||||||||
| FaxNumber: | 8288942229 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 W. MILLS ST. | ||||||||
| Address2: | POLK WELLNESS CENTER | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 28722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288942222 | ||||||||
| FaxNumber: | 8288942229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2011 | ||||||||
| LastUpdateDate: | 11/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 1746 | NC | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.