Healthcare Provider Details

I. General information

NPI: 1891358677
Provider Name (Legal Business Name): MCKENNA TALLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33117 HEMLOCK DR
UNION CITY CA
94587-1459
US

IV. Provider business mailing address

33117 HEMLOCK DR
UNION CITY CA
94587-1459
US

V. Phone/Fax

Practice location:
  • Phone: 510-738-4121
  • Fax:
Mailing address:
  • Phone: 336-312-0455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLCSW130125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: