Provider Demographics
NPI:1265973432
Name:MACCALLUM, MALCOLM GRAHAM (LMFT)
Entity type:Individual
Prefix:
First Name:MALCOLM GRAHAM
Middle Name:
Last Name:MACCALLUM
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15422 S SHANNAN LN
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3382
Mailing Address - Country:US
Mailing Address - Phone:913-827-1573
Mailing Address - Fax:
Practice Address - Street 1:15422 S SHANNAN LN
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-3382
Practice Address - Country:US
Practice Address - Phone:913-827-1573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist