Doctor Name: | DR. LISA WELCH TALLANT |
NPI Number: | 1285718643 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | PSY002416 |
Business Practice Address: | 1532 Dunwoody Village Pkwy Suite 210 Dunwoody, GA - 303384136 |
Business Phone Number: | 4045786543 |
Business Fax Number: | |
Mailing Address: | 1673 Wellshire Ln, DUNWOODY |
State: | GA |
Postal Code: | 303383421 |
Phone Number: | 6785870641 |
Fax Number: | 6785870641 |
NPI Enumeration Date: | 10/24/2006 |
NPI Last Update Date: | 07/23/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | PSY002416 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |