Michael I Callis, PH.D., MSCP

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

19292 Issued in CA

Practice address

4610 Cherry Ave
Orcutt, CA 93455-3830

Phone

(805) 868-0471

NPI assigned

Jan 3, 2010

Last updated

Jan 3, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262476800000",
    "number": "1104156884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4610 CHERRY AVE",
            "city": "ORCUTT",
            "state": "CA",
            "postal_code": "934553830",
            "telephone_number": "805-868-0471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4610 CHERRY AVE",
            "city": "ORCUTT",
            "state": "CA",
            "postal_code": "934553830",
            "telephone_number": "805-868-0471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLIS",
        "first_name": "MICHAEL",
        "middle_name": "I",
        "name_prefix": "Dr.",
        "credential": "PH.D.,  MSCP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-01-03",
        "last_updated": "2010-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "19292",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "19292",
            "primary": true
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "CA",
            "license": "19292",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in Orcutt, CA
• Providers in Orcutt, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.