Provider Demographics
NPI:1952100257
Name:CALLAHAN, JACK (LCPC)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:
Last Name:CALLAHAN
Suffix:
Gender:
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9138 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60513-1547
Mailing Address - Country:US
Mailing Address - Phone:184-734-5242
Mailing Address - Fax:
Practice Address - Street 1:11S270 S JACKSON ST STE 101
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6823
Practice Address - Country:US
Practice Address - Phone:847-345-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.012532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health