Provider Demographics
NPI:1780733824
Name:CALLAHAN, LEE ANN L (PHD)
Entity type:Individual
Prefix:DR
First Name:LEE ANN
Middle Name:L
Last Name:CALLAHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9320 CARMEL MTN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3357
Mailing Address - Country:US
Mailing Address - Phone:619-899-1234
Mailing Address - Fax:858-484-5445
Practice Address - Street 1:9320 CARMEL MTN RD
Practice Address - Street 2:SUITE D
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-3357
Practice Address - Country:US
Practice Address - Phone:619-899-1234
Practice Address - Fax:858-484-5445
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13417103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7011726Medicare UPIN
CP13417Medicare ID - Type Unspecified