Provider Demographics
NPI:1457568966
Name:KALLUS, ROBERT (MS)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:KALLUS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 GOLFVIEW BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-9491
Mailing Address - Country:US
Mailing Address - Phone:219-531-9005
Mailing Address - Fax:
Practice Address - Street 1:2325 177TH ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-1722
Practice Address - Country:US
Practice Address - Phone:708-895-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001592A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist