Provider Demographics
NPI:1659700870
Name:CALLAWAY, BRIAN KILEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:KILEY
Last Name:CALLAWAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 KINGS RD
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-2054
Mailing Address - Country:US
Mailing Address - Phone:308-765-8227
Mailing Address - Fax:308-436-3310
Practice Address - Street 1:1825 KINGS RD
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-2054
Practice Address - Country:US
Practice Address - Phone:308-436-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YP1600X101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral