Provider Demographics
NPI:1497409874
Name:MACCALLUM, REBECCA RUTH
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUTH
Last Name:MACCALLUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13505 S MUR LEN RD STE 105
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1600
Mailing Address - Country:US
Mailing Address - Phone:913-963-1392
Mailing Address - Fax:
Practice Address - Street 1:6750 ANTIOCH RD STE 210
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66204-1260
Practice Address - Country:US
Practice Address - Phone:888-631-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional