Provider Demographics
NPI:1265458202
Name:TALAMANTES, CAROLYN D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:D
Last Name:TALAMANTES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:D
Other - Last Name:PHERNETTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2226 PLYMOUTH ROCK RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79601-4740
Mailing Address - Country:US
Mailing Address - Phone:325-695-3252
Mailing Address - Fax:325-695-3414
Practice Address - Street 1:4225 WOODS PL
Practice Address - Street 2:BLDG. 1
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-7991
Practice Address - Country:US
Practice Address - Phone:325-695-3252
Practice Address - Fax:325-695-3414
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX223121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical