Doctor Name: | SAM TALLMAN |
NPI Number: | 1356499842 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCSW |
License Number: | 2057 |
Business Practice Address: | 855 3rd Street Wheeler, OR - 971479999 |
Business Phone Number: | 1503368686 |
Business Fax Number: | 1503368497 |
Mailing Address: | Po Box 178, MANZANITA |
State: | OR |
Postal Code: | 971300178 |
Phone Number: | 1503368686 |
Fax Number: | 1503368497 |
NPI Enumeration Date: | 01/08/2007 |
NPI Last Update Date: | 03/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 2057 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |