Provider Demographics
NPI:1356572242
Name:O'CALLAGHAN, IAN
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:
Last Name:O'CALLAGHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2284 N NUGENT RD
Mailing Address - Street 2:
Mailing Address - City:LUMMI ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98262-8661
Mailing Address - Country:US
Mailing Address - Phone:360-758-7243
Mailing Address - Fax:360-758-2092
Practice Address - Street 1:2284 N NUGENT RD
Practice Address - Street 2:
Practice Address - City:LUMMI ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98262-8661
Practice Address - Country:US
Practice Address - Phone:360-758-7243
Practice Address - Fax:360-758-2092
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00011211101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor