Provider Demographics
NPI:1205448388
Name:DANIEL CALLAHAN, PHD, PLLC
Entity type:Organization
Organization Name:DANIEL CALLAHAN, PHD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMHC
Authorized Official - Phone:904-240-2157
Mailing Address - Street 1:13500 SUTTON PARK DR S STE 702
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-5290
Mailing Address - Country:US
Mailing Address - Phone:904-240-2157
Mailing Address - Fax:
Practice Address - Street 1:13500 SUTTON PARK DR S STE 702
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5290
Practice Address - Country:US
Practice Address - Phone:904-240-2157
Practice Address - Fax:904-732-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)