Healthcare Provider Details

I. General information

NPI: 1124181276
Provider Name (Legal Business Name): MARC ALAN TALBERT MA LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALLE MEDICO SUITE 5
SANTA FE NM
87505
US

IV. Provider business mailing address

PO BOX 847
SANTA FE NM
87504
US

V. Phone/Fax

Practice location:
  • Phone: 505-780-0309
  • Fax: 505-982-0477
Mailing address:
  • Phone: 505-982-3099
  • Fax: 505-982-0477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberT0096581
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberT0096581
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: