Provider Demographics
NPI:1174572630
Name:MCCALLISTER, ROBIN (PHD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:MCCALLISTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 E RANDOLPH CIR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0723
Mailing Address - Country:US
Mailing Address - Phone:850-386-3082
Mailing Address - Fax:850-385-7978
Practice Address - Street 1:1235 MICCOSUKEE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5007
Practice Address - Country:US
Practice Address - Phone:850-402-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003707103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75758OtherBLUE CROSS BLUE SHIELD