Provider Demographics
NPI:1790438794
Name:JEFFRIES, CALLIE (LMSW)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:JEFFRIES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 US-190 BUS
Mailing Address - Street 2:APT 103
Mailing Address - City:COPPERAS, COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-2546
Mailing Address - Country:US
Mailing Address - Phone:254-315-0205
Mailing Address - Fax:
Practice Address - Street 1:123 YATES RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-6757
Practice Address - Country:US
Practice Address - Phone:254-432-4290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65709104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker