Provider Demographics
NPI:1669263687
Name:BABCOCK MCCALLUM, LEANN MICHELLE (68FCC4F1C5)
Entity type:Individual
Prefix:
First Name:LEANN
Middle Name:MICHELLE
Last Name:BABCOCK MCCALLUM
Suffix:
Gender:F
Credentials:68FCC4F1C5
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:CRESCENT CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95531-8340
Mailing Address - Country:US
Mailing Address - Phone:707-464-4161
Mailing Address - Fax:
Practice Address - Street 1:301 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:CRESCENT CITY
Practice Address - State:CA
Practice Address - Zip Code:95531-8340
Practice Address - Country:US
Practice Address - Phone:707-464-6141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68FCC4F1C5171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach