Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2016013363 | MO |
NPI | 1003344748 |
---|---|
Provider Name | Traci A Callahan |
First Address | Saint Peters, MO 63376-2574 |
Second Address | Saint Peters, MO 63376-2574 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2017 |
Last Update Date | 25/05/2017 |