Healthcare Provider Details

I. General information

NPI: 1932674520
Provider Name (Legal Business Name): TALLA AZEM PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2018
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29425 CHAGRIN BLVD SUITE 340
PEPPER PIKE OH
44122
US

IV. Provider business mailing address

29425 CHAGRIN BLVD, SUITE 340
BEACHWOOD OH
44122-4639
US

V. Phone/Fax

Practice location:
  • Phone: 440-666-1446
  • Fax:
Mailing address:
  • Phone: 440-666-1446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number07714
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: