Provider Demographics
NPI:1093180390
Name:CALLAHAN, PATRINA (BCBA)
Entity Type:Individual
Prefix:
First Name:PATRINA
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 INFANTRY POST RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-1309
Mailing Address - Country:US
Mailing Address - Phone:210-439-4368
Mailing Address - Fax:
Practice Address - Street 1:700 N SAINT MARYS ST STE 1400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-3535
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:No
Enumeration Date:2015-12-11
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
MS160036103K00000X
TX1-17-25558103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst