Provider Demographics
NPI:1205355963
Name:CALLAHAN, SHELBI RAYLENE (ASW)
Entity Type:Individual
Prefix:
First Name:SHELBI
Middle Name:RAYLENE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 LAKE MURRAY BLVD APT 142
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2202
Mailing Address - Country:US
Mailing Address - Phone:661-809-4399
Mailing Address - Fax:
Practice Address - Street 1:10201 MISSION GORGE RD STE O
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3027
Practice Address - Country:US
Practice Address - Phone:619-383-6868
Practice Address - Fax:619-312-2661
Is Sole Proprietor?:No
Enumeration Date:2017-09-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW71912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health