Healthcare Provider Details

I. General information

NPI: 1962849588
Provider Name (Legal Business Name): MARILYN J TALMAGE MFT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2013
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 4TH ST STE E
SANTA ROSA CA
95404-4310
US

IV. Provider business mailing address

PO BOX 147
SANTA ROSA CA
95402-0147
US

V. Phone/Fax

Practice location:
  • Phone: 707-400-8857
  • Fax:
Mailing address:
  • Phone: 509-205-2398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number101022
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: