Provider Demographics
NPI:1710171889
Name:TALLEY, DONNIE JAMES (MC, NCC, MFT)
Entity Type:Individual
Prefix:DR
First Name:DONNIE
Middle Name:JAMES
Last Name:TALLEY
Suffix:
Gender:M
Credentials:MC, NCC, MFT
Other - Prefix:DR
Other - First Name:DON
Other - Middle Name:JAMES
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2261 ELM ST
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-3721
Mailing Address - Country:US
Mailing Address - Phone:707-477-7826
Mailing Address - Fax:
Practice Address - Street 1:2261 ELM ST
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-3721
Practice Address - Country:US
Practice Address - Phone:707-477-7826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2014-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49035106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC #49035OtherCA BBS