NPIMap

Organization Active NPI

P. Douglas Callan & Assoc LTD

  • Clinical Psychologist
  • Fenton, MI
National Provider Identifier
1124233549
Registry record updated Mar 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301002282 Issued in MI
Legal business name
P. DOUGLAS CALLAN & ASSOC LTD
Practice address
1361 N Long Lake Rd
Fenton, MI 48430-8867
Phone
(810) 629-6549
Fax
(810) 629-0614
NPI assigned
May 11, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 14, 2013

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

Authorized official

Name
Mr. Paul Douglas Callan, PHD
Title
Psychologist
Phone
(810) 629-6549

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X 6301002282 MI Primary

Addresses

Primary practice location

1361 N Long Lake Rd
Fenton, MI 48430-8867

Mailing address

1361 N Long Lake Rd
Fenton, MI 48430-8867
Phone (810) 629-6549

Other identifiers 10

IdentifierTypeStateIssuer
2050633OtherMICIGNA
117163OtherMIVALUE OPTIONS
680B54550-0OtherMIBLUE CROSS
38741455OtherMITRICARE
IP285944OtherMIMAGELLAN
P99889OtherMIBLUE CARE NETWORK
8915160OtherMICIGNA
M036569OtherMICHAMPUS
248189OtherMIMHN
266552OtherMIHORIZON

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1178841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363219200000",
    "number": "1124233549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1361 N LONG LAKE RD",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484308867",
            "telephone_number": "810-629-6549",
            "fax_number": "810-629-0614"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1361 N LONG LAKE RD",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484308867",
            "telephone_number": "810-629-6549",
            "fax_number": "810-629-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P. DOUGLAS CALLAN & ASSOC LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-11",
        "last_updated": "2013-03-14",
        "status": "A",
        "authorized_official_last_name": "CALLAN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "PSYCHOLOGIST",
        "authorized_official_telephone_number": "810-629-6549",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301002282",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2050633",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "117163",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "680B54550-0",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "38741455",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "IP285944",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "P99889",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8915160",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "M036569",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "248189",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON",
            "identifier": "266552",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2013; 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.