Provider Demographics
NPI:1497443030
Name:TALLIER, COREY MATTHEW (LPC)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:MATTHEW
Last Name:TALLIER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 JEFFERS RDG
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-3844
Mailing Address - Country:US
Mailing Address - Phone:715-314-0054
Mailing Address - Fax:
Practice Address - Street 1:1000 STARR AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-1821
Practice Address - Country:US
Practice Address - Phone:715-858-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7260-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health