Provider Demographics
NPI:1518276716
Name:CALLISTER, PAUL THOMAS (CMHC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:CALLISTER
Suffix:
Gender:M
Credentials:CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4102
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84110
Mailing Address - Country:US
Mailing Address - Phone:801-755-5138
Mailing Address - Fax:
Practice Address - Street 1:275 E SOUTH TEMPLE STE 202
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-1273
Practice Address - Country:US
Practice Address - Phone:801-755-5138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT76991046009101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor