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General NPI Number Information
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NPI Number | 1962011635
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Entity Type | Individual
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Provider Name | CHAD ANDREW TALBOT LPCC
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Gender | Male
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Dates
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Enumeration Date | 07/28/2020
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 9325 UPLAND LN N STE 210
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City | MAPLE GROVE
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State | MN
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Zip | 55369-5777
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Country | US
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Telephone | 612-915-0049
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Fax |
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Provider Business Mailing Address
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Address Line | 19591 STATION ST APT 308
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City | BIG LAKE
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State | MN
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Zip | 55309-9436
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Country | US
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Telephone | 612-242-2519
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 4297
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License Number State | MN
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