Provider Demographics
NPI:1225574031
Name:TALLMAN, JEREMY RYAN (LCPC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:RYAN
Last Name:TALLMAN
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 ROUTE 108
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1990
Mailing Address - Country:US
Mailing Address - Phone:410-740-1901
Mailing Address - Fax:410-740-2503
Practice Address - Street 1:9030 ROUTE 108
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1990
Practice Address - Country:US
Practice Address - Phone:410-740-1901
Practice Address - Fax:410-740-2503
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC7560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health