Provider Demographics
NPI:1144591652
Name:TALBOTT, TAMORA MARIE (LLPC)
Entity Type:Individual
Prefix:MS
First Name:TAMORA
Middle Name:MARIE
Last Name:TALBOTT
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 S CREYTS RD STE F
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-8268
Mailing Address - Country:US
Mailing Address - Phone:517-323-1767
Mailing Address - Fax:
Practice Address - Street 1:516 S CREYTS RD
Practice Address - Street 2:SUITE F
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-8268
Practice Address - Country:US
Practice Address - Phone:517-323-1767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-16
Last Update Date:2012-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012713101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor