Provider Demographics
NPI:1760092456
Name:LEMIEUX, CALLISTA GABRIELLE
Entity Type:Individual
Prefix:
First Name:CALLISTA
Middle Name:GABRIELLE
Last Name:LEMIEUX
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CALLISTA
Other - Middle Name:GABRIELLE
Other - Last Name:WHALEN-LEMIEUX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:16878A HURRICANE LN
Mailing Address - Street 2:
Mailing Address - City:SAINT ROBERT
Mailing Address - State:MO
Mailing Address - Zip Code:65584-4795
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16878A HURRICANE LN
Practice Address - Street 2:
Practice Address - City:SAINT ROBERT
Practice Address - State:MO
Practice Address - Zip Code:65584-4795
Practice Address - Country:US
Practice Address - Phone:603-275-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician