Basic Information
| Provider Information | |||||||||
| NPI: | 1568900702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'CALLAGHAN | ||||||||
| FirstName: | KERI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5850 GRANITE PKWY STE 600 | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750246753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4696941754 | ||||||||
| FaxNumber: | 8187588015 | ||||||||
| Practice Location | |||||||||
| Address1: | 5168 N BLYTHE AVE STE 102 | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937226478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592555900 | ||||||||
| FaxNumber: | 5599811212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2017 | ||||||||
| LastUpdateDate: | 08/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-24163 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.