Provider Demographics
NPI:1164531810
Name:GILL-CALLAHAN, MONICA LANDABURU (MA)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:LANDABURU
Last Name:GILL-CALLAHAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MONIQUE
Other - Middle Name:LANDABURU
Other - Last Name:GILL-CALLAHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:10480 CANADEO CIRCLE
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95757
Mailing Address - Country:US
Mailing Address - Phone:916-714-8025
Mailing Address - Fax:916-282-1940
Practice Address - Street 1:4875 BROADWAY
Practice Address - Street 2:STE 125
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95820
Practice Address - Country:US
Practice Address - Phone:916-874-2512
Practice Address - Fax:916-875-1190
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43697106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist