Provider Demographics
NPI:1437200136
Name:TALLEY, ERNEST BRADFORD (EDS)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:BRADFORD
Last Name:TALLEY
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-3760
Mailing Address - Country:US
Mailing Address - Phone:928-344-6856
Mailing Address - Fax:928-344-6930
Practice Address - Street 1:281 W 24TH ST
Practice Address - Street 2:SUITE 126
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8500
Practice Address - Country:US
Practice Address - Phone:928-344-6856
Practice Address - Fax:928-344-6930
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool