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General NPI Number Information
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NPI Number | 1285718643
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Entity Type | Individual
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Provider Name | LISA WELCH TALLANT PSYD
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/23/2013
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Provider Practice Location Address
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Address Line | 1532 DUNWOODY VILLAGE PKWY SUITE 210
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City | DUNWOODY
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State | GA
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Zip | 30338-4136
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Country | US
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Telephone | 404-578-6543
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Fax |
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Provider Business Mailing Address
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Address Line | 1673 WELLSHIRE LN
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City | DUNWOODY
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State | GA
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Zip | 30338-3421
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Country | US
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Telephone | 678-587-0641
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Fax | 678-587-0641
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002416
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License Number State | GA
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