Healthcare Provider Details

I. General information

NPI: 1720135460
Provider Name (Legal Business Name): EVA L TALBOTT MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVA L. VON SCHRILTZ

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 11/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S PARKSIDE DRIVE
COLORADO SPRINGS CO
80910
US

IV. Provider business mailing address

220 RUSKIN DR
COLORADO SPRINGS CO
80910
US

V. Phone/Fax

Practice location:
  • Phone: 719-572-6340
  • Fax: 719-447-4792
Mailing address:
  • Phone: 719-572-6100
  • Fax: 719-572-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4413
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1677
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: