Provider Demographics
NPI:1003269986
Name:TALLCOUCH, DAMON (NMD)
Entity Type:Individual
Prefix:
First Name:DAMON
Middle Name:
Last Name:TALLCOUCH
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7331 E OSBORN DR
Mailing Address - Street 2:#330
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6435
Mailing Address - Country:US
Mailing Address - Phone:480-990-1111
Mailing Address - Fax:480-990-1110
Practice Address - Street 1:7331 E OSBORN DR
Practice Address - Street 2:#330
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6435
Practice Address - Country:US
Practice Address - Phone:480-990-1111
Practice Address - Fax:480-990-1110
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ161529175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath