Basic Information
| Provider Information | |||||||||
| NPI: | 1457679136 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALLAHAN | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | LOUISE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MFTI | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CALLAHAN | ||||||||
| OtherFirstName: | LYNDA | ||||||||
| OtherMiddleName: | LOUISE | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LMFT | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 902 S MYRTLE AVE | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | MONROVIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910163427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263573258 | ||||||||
| FaxNumber: | 6263010868 | ||||||||
| Practice Location | |||||||||
| Address1: | 902 S MYRTLE AVE | ||||||||
| Address2: | SECOND FLOOR | ||||||||
| City: | MONROVIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910163427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263573258 | ||||||||
| FaxNumber: | 6263010868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2010 | ||||||||
| LastUpdateDate: | 12/11/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 60595 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 60595 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 77473 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.