Provider Demographics
NPI:1801211446
Name:TALBOTT, DOUGLAS (MA)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:TALBOTT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2132 FIESTA WAY
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-4035
Mailing Address - Country:US
Mailing Address - Phone:863-414-7427
Mailing Address - Fax:
Practice Address - Street 1:2132 FIESTA WAY
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-4035
Practice Address - Country:US
Practice Address - Phone:863-414-7427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor