Provider Demographics
NPI:1306050349
Name:CALLIHAN, HENRY MATT III (LADAC)
Entity type:Individual
Prefix:MR
First Name:HENRY
Middle Name:MATT
Last Name:CALLIHAN
Suffix:III
Gender:M
Credentials:LADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2200 MORRIS HILL RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2818
Mailing Address - Country:US
Mailing Address - Phone:423-894-4220
Mailing Address - Fax:423-499-2320
Practice Address - Street 1:2200 MORRIS HILL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2818
Practice Address - Country:US
Practice Address - Phone:423-894-4220
Practice Address - Fax:423-499-2320
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLDC0000000084101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)