Provider Demographics
NPI:1548761349
Name:MCCALLISTER, KASEY (BS)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:
Other - Last Name:PIGUET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:178 PRIVATE DRIVE 19423
Mailing Address - Street 2:
Mailing Address - City:SOUTH POINT
Mailing Address - State:OH
Mailing Address - Zip Code:45680
Mailing Address - Country:US
Mailing Address - Phone:740-451-0741
Mailing Address - Fax:
Practice Address - Street 1:178 PRIVATE DRIVE 19423
Practice Address - Street 2:
Practice Address - City:SOUTH POINT
Practice Address - State:OH
Practice Address - Zip Code:45680
Practice Address - Country:US
Practice Address - Phone:740-451-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator