Provider Demographics
NPI:1962849588
Name:TALMAGE, MARILYN J (MFT, LPCC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:TALMAGE
Suffix:
Gender:F
Credentials:MFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 147
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95402
Mailing Address - Country:US
Mailing Address - Phone:509-205-2398
Mailing Address - Fax:
Practice Address - Street 1:1023 4TH ST STE E
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4310
Practice Address - Country:US
Practice Address - Phone:707-400-8857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA101022106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health