| Doctor Name: | POORVA TALAPATRA |
| NPI Number: | 1013210194 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.ED., LCPC |
| License Number: | 178005097 |
| Business Practice Address: | 400 S Lewis Ln Carbondale, IL - 629013547 |
| Business Phone Number: | 6185199900 |
| Business Fax Number: | 6185291384 |
| Mailing Address: | Po Box 577, 109 California St CARTERVILLE |
| State: | IL |
| Postal Code: | 629180577 |
| Phone Number: | 6189858221 |
| Fax Number: | 6189854635 |
| NPI Enumeration Date: | 12/13/2010 |
| NPI Last Update Date: | 08/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 178005097 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |