Heidi Lynn Callis, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

0-14-10205 Issued in VA

Practice address

5472 Kings Dr
Gloucester, VA 23061-2906

Phone

(804) 824-2396

Fax

(804) 824-2397

NPI assigned

Jun 27, 2014

Last updated

Nov 8, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Blue Water ABA Therapy, Co

  • Behavior Analyst
  • Gloucester, VA
  • NPI 1033602552
  NPD Authorized official

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1760897730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5472 KINGS DR",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230612906",
            "telephone_number": "804-824-2396",
            "fax_number": "804-824-2397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5472 KINGS DR",
            "city": "GLOUCESTER",
            "state": "VA",
            "postal_code": "230612906",
            "telephone_number": "804-824-2396",
            "fax_number": "804-824-2397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALLIS",
        "first_name": "HEIDI",
        "middle_name": "LYNN",
        "name_prefix": "Ms.",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-06-27",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "0-14-10205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brenda Burkholder, LPC
• Erin Butler
• Meghan Butler
• Jason Cahill
• Lee Ann Cahill
• Amanda Campagnola, LCSW
• Annie N Campbell
• Linda Lee Canham
• Taylour Canose
• Leonora Caparas

• Behavior Analyst in Gloucester, VA
• Providers in Gloucester, VA by specialty
• Behavior Analyst in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; 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.