Provider Demographics
NPI:1730909151
Name:CALLAGHAN, NATHAN
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:CALLAGHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 W AUBURN TRL
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-5001
Mailing Address - Country:US
Mailing Address - Phone:810-623-5065
Mailing Address - Fax:
Practice Address - Street 1:3250 UNIVERSITY DR STE 115
Practice Address - Street 2:
Practice Address - City:AUBURN HILLS
Practice Address - State:MI
Practice Address - Zip Code:48326-2391
Practice Address - Country:US
Practice Address - Phone:248-844-2647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6362009771103TC1900X
MI6451023165101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling