Provider Demographics
NPI:1003939513
Name:CALLAN, JEANI (MA)
Entity Type:Individual
Prefix:MS
First Name:JEANI
Middle Name:
Last Name:CALLAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 W OCEAN AVE
Mailing Address - Street 2:APT. A
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-6643
Mailing Address - Country:US
Mailing Address - Phone:805-294-0363
Mailing Address - Fax:
Practice Address - Street 1:115 CIVIC CENTER PLZ
Practice Address - Street 2:PROBATION
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6916
Practice Address - Country:US
Practice Address - Phone:805-737-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)