Provider Demographics
NPI:1043840242
Name:TALLANT COUNSELING SERVICES
Entity Type:Organization
Organization Name:TALLANT COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TALLANT
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:765-620-6977
Mailing Address - Street 1:207 W STATE ST APT D
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064-1063
Mailing Address - Country:US
Mailing Address - Phone:765-778-3223
Mailing Address - Fax:765-221-9136
Practice Address - Street 1:207 W STATE ST APT D
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-1063
Practice Address - Country:US
Practice Address - Phone:765-778-3223
Practice Address - Fax:765-221-9136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN35001682AOtherSTATE LICENSE NUMBER