Provider Demographics
NPI:1760531529
Name:TALLEY, ERICA BARFIELD (LMSW)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:BARFIELD
Last Name:TALLEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 MARINER DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-3769
Mailing Address - Country:US
Mailing Address - Phone:361-579-6885
Mailing Address - Fax:361-579-6885
Practice Address - Street 1:416 MARINER DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3769
Practice Address - Country:US
Practice Address - Phone:361-579-6885
Practice Address - Fax:361-579-6885
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31615104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1786469-01Medicaid