Provider Demographics
NPI:1316370976
Name:CALLOWAY, DONNA MICHELLE
Entity Type:Individual
Prefix:MISS
First Name:DONNA
Middle Name:MICHELLE
Last Name:CALLOWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 BROWNING DR
Mailing Address - Street 2:#12305
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-6084
Mailing Address - Country:US
Mailing Address - Phone:817-714-4969
Mailing Address - Fax:
Practice Address - Street 1:7465 W LAKE MEAD BLVD
Practice Address - Street 2:# 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1032
Practice Address - Country:US
Practice Address - Phone:702-658-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-18
Last Update Date:2013-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health