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General NPI Number Information
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NPI Number | 1639678113
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Entity Type | Organization
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Legal Business Name | SUSAN TALMAGE, PHD, PA
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Dates
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Enumeration Date | 02/09/2018
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 20 VANGUARD WAY
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City | DALLAS
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State | TX
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Zip | 75243-6510
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Country | US
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Telephone | 214-206-6822
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Fax | 214-247-0632
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Provider Business Mailing Address
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Address Line | 20 VANGUARD WAY
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City | DALLAS
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State | TX
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Zip | 75243-6510
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Country | US
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Telephone | 214-206-6822
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Fax | 214-247-0632
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUSAN TALMAGE
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Credential | PHD
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Telephone | 214-206-6822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 24635
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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