Healthcare Provider Details

I. General information

NPI: 1043840242
Provider Name (Legal Business Name): TALLANT COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2020
Last Update Date: 01/16/2020
Certification Date: 01/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W STATE ST APT D
PENDLETON IN
46064-1063
US

IV. Provider business mailing address

207 W STATE ST APT D
PENDLETON IN
46064-1063
US

V. Phone/Fax

Practice location:
  • Phone: 765-778-3223
  • Fax: 765-221-9136
Mailing address:
  • Phone: 765-778-3223
  • Fax: 765-221-9136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ANNA M TALLANT
Title or Position: OWNER/OPERATOR
Credential: LMHC
Phone: 765-620-6977