Provider Demographics
NPI:1295249464
Name:CALLAHAN, KORINA (MED, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KORINA
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:KORINA
Other - Middle Name:
Other - Last Name:CHAPMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, BCBA, LBA
Mailing Address - Street 1:2615 E HEIDI LOOP
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86004-1845
Mailing Address - Country:US
Mailing Address - Phone:765-586-2723
Mailing Address - Fax:
Practice Address - Street 1:2615 E HEIDI LOOP
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86004-1845
Practice Address - Country:US
Practice Address - Phone:765-586-2723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-27
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-17-25608103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst