Provider Demographics
NPI:1023207339
Name:TALLEY, PRISCILLA UNIS (LBSW, LLPC)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:UNIS
Last Name:TALLEY
Suffix:
Gender:F
Credentials:LBSW, LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22140 DANTE ST
Mailing Address - Street 2:APT 210
Mailing Address - City:OAK PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48237
Mailing Address - Country:US
Mailing Address - Phone:248-548-4835
Mailing Address - Fax:
Practice Address - Street 1:22140 DANTE ST
Practice Address - Street 2:APT 210
Practice Address - City:OAK PARK
Practice Address - State:MI
Practice Address - Zip Code:48237-2840
Practice Address - Country:US
Practice Address - Phone:248-548-4835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401010391101Y00000X
MI6802079682104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor