Provider Demographics
NPI:1972653988
Name:MCCALLUM, LAWRENCE WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:WAYNE
Last Name:MCCALLUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 PINEHILL RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-1718
Mailing Address - Country:US
Mailing Address - Phone:563-355-3474
Mailing Address - Fax:
Practice Address - Street 1:639 38TH ST
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-2210
Practice Address - Country:US
Practice Address - Phone:309-794-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0071003425103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist