Provider Demographics
NPI:1124181276
Name:TALBERT, MARC ALAN (MA LMHC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:ALAN
Last Name:TALBERT
Suffix:
Gender:M
Credentials:MA LMHC
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 847
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87504
Mailing Address - Country:US
Mailing Address - Phone:505-982-3099
Mailing Address - Fax:505-982-0477
Practice Address - Street 1:11 CALLE MEDICO
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-780-0309
Practice Address - Fax:505-982-0477
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT0096581103T00000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor