Provider Demographics
NPI:1457472003
Name:CALLAN, ROBERT WILLIAM (MFT)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:CALLAN
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 1:995 HELLING WAY
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-8619
Mailing Address - Country:US
Mailing Address - Phone:530-265-7135
Mailing Address - Fax:530-265-9376
Practice Address - Street 1:995 HELLING WAY
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-8619
Practice Address - Country:US
Practice Address - Phone:530-265-7135
Practice Address - Fax:530-265-9376
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42856101YP2500X
CAMFT 42856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional