Provider Demographics
NPI:1134309842
Name:CALLIHAM, KEVIN EUGENE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:EUGENE
Last Name:CALLIHAM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8530 HOLLOWAY DR
Mailing Address - Street 2:SUITE #305
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-2475
Mailing Address - Country:US
Mailing Address - Phone:310-652-0113
Mailing Address - Fax:310-652-0113
Practice Address - Street 1:8530 HOLLOWAY DR
Practice Address - Street 2:SUITE #305
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-2475
Practice Address - Country:US
Practice Address - Phone:310-652-0113
Practice Address - Fax:310-652-0113
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-09
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA209781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical