Provider Demographics
NPI:1316080658
Name:MCCAL, KEVIN (PHD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:MCCAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HQ AFSOC/SG
Mailing Address - Street 2:427 CODY AVENUE
Mailing Address - City:HURLBURT FIELD
Mailing Address - State:FL
Mailing Address - Zip Code:32544
Mailing Address - Country:US
Mailing Address - Phone:850-884-2269
Mailing Address - Fax:
Practice Address - Street 1:1 SOMDG/MENTAL HEALTH
Practice Address - Street 2:130 LETOURNEAU CIRCLE
Practice Address - City:HURLBURT FIELD
Practice Address - State:FL
Practice Address - Zip Code:32544
Practice Address - Country:US
Practice Address - Phone:850-881-4237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041081A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical