Provider Demographics
NPI:1851668131
Name:CATHERINE CALLENDER LLC
Entity Type:Organization
Organization Name:CATHERINE CALLENDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:601-925-8194
Mailing Address - Street 1:134 FAIRMONT ST
Mailing Address - Street 2:STE E
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4739
Mailing Address - Country:US
Mailing Address - Phone:601-925-8194
Mailing Address - Fax:601-925-8196
Practice Address - Street 1:134 FAIRMONT ST
Practice Address - Street 2:STE E
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-4739
Practice Address - Country:US
Practice Address - Phone:601-925-8194
Practice Address - Fax:601-925-8196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC3503104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1174652523OtherMEDICARE
MS00123406Medicaid
MS00123406Medicaid