MEDICARE: HEATHER TALLEY LPC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	15733-132	WI
2	101YP2500X	Professional Counselor	5426-125	WI

General Provider Information

NPI Number	:	1346517281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER TALLEY LPC

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:	262-999-3495
Fax Number	:

Provider Business Practice Location Address
First Line	:	5650 N GREEN BAY AVE STE 205
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-4446
Country	:	US
Telephone Number	:	262-999-3495
Fax Number	:

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

Provider Enumeration Date	:	11/21/2011
Last Update Date	:	06/02/2025

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