MEDICARE: MS. MICHELLE DIONNE TALLEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS22079	CA

General Provider Information

NPI Number	:	1124206180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE DIONNE TALLEY LCSW

Provider Business Mailing Address
First Line	:	369 S DOHENY DR # 253
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3508
Country	:	US
Telephone Number	:	319-770-3675
Fax Number	:

Provider Business Practice Location Address
First Line	:	369 S DOHENY DR # 253
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3508
Country	:	US
Telephone Number	:	319-770-3675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/01/2008

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