Healthcare Provider Details

I. General information

NPI: 1346144532
Provider Name (Legal Business Name): DAVIS TALLEY PSY.D.
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 TERRY ST STE 200
LONGMONT CO
80501-5464
US

IV. Provider business mailing address

2500 S ABILENE ST # 440905
AURORA CO
80014-2322
US

V. Phone/Fax

Practice location:
  • Phone: 954-366-9978
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: