Provider Demographics
NPI:1457444002
Name:CALLAHAN, IAN MICHAEL (MFT)
Entity Type:Individual
Prefix:MR
First Name:IAN
Middle Name:MICHAEL
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 TACOMA AVE S
Mailing Address - Street 2:PIERCE COUNTY JAIL: MENTAL HEALTH
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98402-2105
Mailing Address - Country:US
Mailing Address - Phone:253-798-4013
Mailing Address - Fax:
Practice Address - Street 1:325 EAST PIONEER AVENUE
Practice Address - Street 2:MULTICARE GOOD SAMARITAN BEHAVIORAL HEALTH
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3265
Practice Address - Country:US
Practice Address - Phone:253-697-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC60329803101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACG60152051Medicaid
WAMC60329803Medicaid