1669529699 NPI number — PATRICIA L TALBOTT MA,LPC,CAC-1,MSW

Table of content: PATRICIA L TALBOTT MA,LPC,CAC-1,MSW (NPI 1669529699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669529699 NPI number — PATRICIA L TALBOTT MA,LPC,CAC-1,MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TALBOTT
Provider First Name:
PATRICIA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA,LPC,CAC-1,MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669529699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3351 CLAYSTONE ST SE
Provider Second Line Business Mailing Address:
STE. 212
Provider Business Mailing Address City Name:
GRAND RAPIDS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49546-5781
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-954-1992
Provider Business Mailing Address Fax Number:
616-954-1998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3351 CLAYSTONE ST SE
Provider Second Line Business Practice Location Address:
STE. 212
Provider Business Practice Location Address City Name:
GRAND RAPIDS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49546-5781
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-954-1992
Provider Business Practice Location Address Fax Number:
616-954-1998
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  6401006469 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 104100000X , with the licence number: 6801058421 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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