Healthcare Provider Details

I. General information

NPI: 1376216085
Provider Name (Legal Business Name): DENARA TALLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2021
Last Update Date: 01/22/2022
Certification Date: 09/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7156 CARDINAL WALK LN
NORTH LAS VEGAS NV
89084-3146
US

IV. Provider business mailing address

7156 CARDINAL WALK LN
NORTH LAS VEGAS NV
89084-3146
US

V. Phone/Fax

Practice location:
  • Phone: 702-330-7144
  • Fax:
Mailing address:
  • Phone: 702-330-7144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number7783-S
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberIC-1727
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: