Provider Demographics
NPI:1881823706
Name:MAY, TALLY L (MSW)
Entity Type:Individual
Prefix:
First Name:TALLY
Middle Name:L
Last Name:MAY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:TALLY
Other - Middle Name:L
Other - Last Name:SIMMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2701 W PICACHO AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88007-4732
Mailing Address - Country:US
Mailing Address - Phone:575-652-3646
Mailing Address - Fax:575-680-2415
Practice Address - Street 1:2701 W PICACHO AVE STE 4
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88007-4732
Practice Address - Country:US
Practice Address - Phone:575-652-3646
Practice Address - Fax:575-680-2415
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMX-093871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical