Provider Demographics
NPI:1609986496
Name:CALLAHAN, BETSY NICHOLSON (DSW LCSW)
Entity Type:Individual
Prefix:DR
First Name:BETSY
Middle Name:NICHOLSON
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:DSW LCSW
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:NICHOLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1782 E HOLLADAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2606
Mailing Address - Country:US
Mailing Address - Phone:801-272-3584
Mailing Address - Fax:801-272-3584
Practice Address - Street 1:LIFESKILLS SUPPORT CTR
Practice Address - Street 2:HILL AIR FORCE BASE
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056
Practice Address - Country:US
Practice Address - Phone:801-777-7909
Practice Address - Fax:801-777-4490
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13141235011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1314123501OtherLCSW DIV OF OCC. PROF LIC