Provider Demographics
NPI:1932648359
Name:PERIN-CALLAHAN, MICHELLE JG (MS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JG
Last Name:PERIN-CALLAHAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37875 JASPER LOWELL RD.
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:OR
Mailing Address - Zip Code:97438
Mailing Address - Country:US
Mailing Address - Phone:541-747-1235
Mailing Address - Fax:541-747-4722
Practice Address - Street 1:341 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3212
Practice Address - Country:US
Practice Address - Phone:541-342-8255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR144476146N00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic