Provider Demographics
NPI:1417226945
Name:CALLAHAN, MICHELLE (LSCSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:LSCSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11027 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4905
Mailing Address - Country:US
Mailing Address - Phone:913-961-1719
Mailing Address - Fax:
Practice Address - Street 1:40A WESTWOODS DR
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-3519
Practice Address - Country:US
Practice Address - Phone:816-781-2349
Practice Address - Fax:816-792-8232
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-29
Last Update Date:2013-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060082001041C0700X
KS36141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200866370AMedicaid