Doctor Name: | MARK TALAGA |
NPI Number: | 1043637366 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LPC |
License Number: | 178.009897 |
Business Practice Address: | 350 S Northwest Hwy Suite 300 Park Ridge, IL - 600684216 |
Business Phone Number: | 3126249815 |
Business Fax Number: | |
Mailing Address: | 350 S Northwest Hwy, Suite 300 PARK RIDGE |
State: | IL |
Postal Code: | 600684216 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/25/2014 |
NPI Last Update Date: | 03/25/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 178.009897 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |