Provider Demographics
NPI:1134986607
Name:CALLOWAY HEALTH AND PSYCH LLC
Entity type:Organization
Organization Name:CALLOWAY HEALTH AND PSYCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:310-651-4279
Mailing Address - Street 1:2880 BICENTENNIAL PKWY STE 100
Mailing Address - Street 2:PMB 41
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-4484
Mailing Address - Country:US
Mailing Address - Phone:310-651-4279
Mailing Address - Fax:
Practice Address - Street 1:4760 S PECOS RD # 103-23
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6038
Practice Address - Country:US
Practice Address - Phone:213-948-7792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty