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General NPI Number Information
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NPI Number | 1437200136
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Entity Type | Individual
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Provider Name | ERNEST BRADFORD TALLEY ED.S
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 281 W 24TH ST SUITE 126
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City | YUMA
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State | AZ
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Zip | 85364-8500
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Country | US
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Telephone | 928-344-6856
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Fax | 928-344-6930
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Provider Business Mailing Address
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Address Line | 1101 S 8TH AVE
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City | YUMA
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State | AZ
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Zip | 85364-3760
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Country | US
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Telephone | 928-344-6856
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Fax | 928-344-6930
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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