Provider Demographics
NPI:1619244571
Name:CALLOWAY, JORDAN ALLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JORDAN
Middle Name:ALLEN
Last Name:CALLOWAY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 TUSCANY BEND ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5545
Mailing Address - Country:US
Mailing Address - Phone:386-479-7714
Mailing Address - Fax:
Practice Address - Street 1:853 STATE ROAD 436 STE 2045
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-5480
Practice Address - Country:US
Practice Address - Phone:407-598-0202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10485103TC0700X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical