Provider Demographics
NPI:1114525979
Name:DEBAUN, TALENA WILSON (CLC, MAC, LAC)
Entity Type:Individual
Prefix:MS
First Name:TALENA
Middle Name:WILSON
Last Name:DEBAUN
Suffix:
Gender:F
Credentials:CLC, MAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 493
Mailing Address - Street 2:
Mailing Address - City:PEARCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85625-0493
Mailing Address - Country:US
Mailing Address - Phone:520-444-2349
Mailing Address - Fax:
Practice Address - Street 1:308 N SAGE ST
Practice Address - Street 2:
Practice Address - City:PEARCE
Practice Address - State:AZ
Practice Address - Zip Code:85625-4009
Practice Address - Country:US
Practice Address - Phone:520-444-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ089171100000X
173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No173C00000XOther Service ProvidersReflexologist