Healthcare Provider Details

I. General information

NPI: 1386366870
Provider Name (Legal Business Name): KENDRA TALLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 MCHAN ST
GREENVILLE SC
29605-3877
US

IV. Provider business mailing address

3 MCHAN ST
GREENVILLE SC
29605-3877
US

V. Phone/Fax

Practice location:
  • Phone: 850-544-5813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12464
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH22053
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: