Doctor Name: | NILE KENNETH TALLMAN |
NPI Number: | 1477944676 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | LCPC |
License Number: | 180.005080 |
Business Practice Address: | 111 W Main St West Dundee, IL - 601182016 |
Business Phone Number: | 8475714035 |
Business Fax Number: | |
Mailing Address: | 111 W Main St, WEST DUNDEE |
State: | IL |
Postal Code: | 601182016 |
Phone Number: | 8475714035 |
Fax Number: | |
NPI Enumeration Date: | 02/09/2015 |
NPI Last Update Date: | 02/09/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 180.005080 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |