Provider Demographics
NPI:1063570356
Name:IRENE A CALHOUN PHD PC
Entity type:Organization
Organization Name:IRENE A CALHOUN PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:AMANDA
Authorized Official - Last Name:CALHOUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-941-2377
Mailing Address - Street 1:3701 BURGOON ROAD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-1715
Mailing Address - Country:US
Mailing Address - Phone:814-941-2377
Mailing Address - Fax:814-944-0419
Practice Address - Street 1:3701 BURGOON ROAD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-1715
Practice Address - Country:US
Practice Address - Phone:814-941-2377
Practice Address - Fax:814-944-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004656L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA206067OtherUPMC HEALTHCARE
PA642738OtherHIGHMARK BCBS
PACA092782Medicare ID - Type Unspecified