Provider Demographics
NPI:1699812743
Name:CALLAHAN, DEVIN ARDELL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DEVIN
Middle Name:ARDELL
Last Name:CALLAHAN
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 1:9320 CARMEL MTN RD STE D
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-2159
Mailing Address - Country:US
Mailing Address - Phone:619-899-0148
Mailing Address - Fax:858-484-5445
Practice Address - Street 1:9320 CARMEL MTN RD STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2159
Practice Address - Country:US
Practice Address - Phone:619-899-0148
Practice Address - Fax:858-484-5445
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY19400Medicaid
CACP19400Medicare ID - Type Unspecified
Q02356Medicare UPIN