Provider Demographics
NPI:1871762781
Name:ONEESE, CALLIE JUNG (PHD)
Entity type:Individual
Prefix:DR
First Name:CALLIE
Middle Name:JUNG
Last Name:ONEESE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CALLIE
Other - Middle Name:JUNG
Other - Last Name:ONEESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CALLIE J BAIR
Mailing Address - Street 1:3420 DAWSON LOOP
Mailing Address - Street 2:DAWSON LOOP
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3960 PATIENT CARE WAY
Practice Address - Street 2:STE 104
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4275
Practice Address - Country:US
Practice Address - Phone:517-887-9801
Practice Address - Fax:517-887-9826
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-25
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630015203103T00000X
MI6301015203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty