Provider Demographics
NPI:1710011192
Name:CALLAHAN, MARIANNE H (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:H
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19701 HAMILTON AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-1352
Mailing Address - Country:US
Mailing Address - Phone:310-817-2177
Mailing Address - Fax:
Practice Address - Street 1:19701 HAMILTON AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-1352
Practice Address - Country:US
Practice Address - Phone:310-817-2177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2009-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35956106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist