Provider Demographics
NPI:1417261413
Name:CALLEY, ANN BERNETTE (LPC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:BERNETTE
Last Name:CALLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:BERNETTE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:679 W. ELM ST.
Mailing Address - Street 2:#9
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3568
Mailing Address - Country:US
Mailing Address - Phone:417-532-0664
Mailing Address - Fax:417-532-2088
Practice Address - Street 1:679 W. ELM ST.
Practice Address - Street 2:#9
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3568
Practice Address - Country:US
Practice Address - Phone:417-532-0664
Practice Address - Fax:417-532-2088
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007024893101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional