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General NPI Number Information
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NPI Number | 1760963987
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Entity Type | Individual
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Provider Name | ALONZO TALTON II LADC/MH
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Gender | Male
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Dates
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Enumeration Date | 08/25/2018
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 15 W 6TH ST
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City | TULSA
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State | OK
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Zip | 74119-5415
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Country | US
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Telephone | 918-295-5055
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Fax |
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Provider Business Mailing Address
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Address Line | 2919 EMBASSY ROW
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City | FLOSSMOOR
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State | IL
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Zip | 60422-2209
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Country | US
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Telephone | 925-303-5807
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1481
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License Number State | OK
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