Provider Demographics
NPI:1427552264
Name:CALLAHAN, CORI LYNNETTE (MA, LPC, RBT)
Entity Type:Individual
Prefix:MRS
First Name:CORI
Middle Name:LYNNETTE
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MA, LPC, RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 BLUE SAGE LN
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4278
Mailing Address - Country:US
Mailing Address - Phone:210-683-1820
Mailing Address - Fax:
Practice Address - Street 1:11901 TOEPPERWEIN RD STE 901
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3158
Practice Address - Country:US
Practice Address - Phone:210-286-2586
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty