Provider Demographics
NPI:1487370664
Name:CALLAHAN, PAUL VINCENT (EDD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:VINCENT
Last Name:CALLAHAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 FARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809-6826
Mailing Address - Country:US
Mailing Address - Phone:863-640-0077
Mailing Address - Fax:
Practice Address - Street 1:3030 N ROCKY POINT DR W STE 665
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5906
Practice Address - Country:US
Practice Address - Phone:813-286-2959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty