Provider Demographics
NPI:1407566862
Name:TALBOO, JOHN L
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:TALBOO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7344 PEARL RD STE 2B
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44130-9602
Mailing Address - Country:US
Mailing Address - Phone:440-625-0081
Mailing Address - Fax:440-625-0053
Practice Address - Street 1:7344 PEARL RD STE 2B
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-9602
Practice Address - Country:US
Practice Address - Phone:440-625-0081
Practice Address - Fax:440-625-0053
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty