Provider Demographics
NPI:1326419797
Name:CALLIHAN, SHANETHA (MSW)
Entity type:Individual
Prefix:
First Name:SHANETHA
Middle Name:
Last Name:CALLIHAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SHANETHA
Other - Middle Name:
Other - Last Name:CALLIHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW RSW
Mailing Address - Street 1:8732 FOX GATE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-5238
Mailing Address - Country:US
Mailing Address - Phone:225-405-9063
Mailing Address - Fax:225-926-9708
Practice Address - Street 1:8706 JEFFERSON HWY STE A
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2233
Practice Address - Country:US
Practice Address - Phone:225-926-9706
Practice Address - Fax:225-926-9708
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA10062104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1326419797Medicaid