Provider Demographics
NPI:1992397830
Name:TALAVERA, WENDY VANNESA (LCPC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:VANNESA
Last Name:TALAVERA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 LUCERNE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4312
Mailing Address - Country:US
Mailing Address - Phone:775-220-6263
Mailing Address - Fax:
Practice Address - Street 1:1605 LUCERNE ST STE 205
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4417
Practice Address - Country:US
Practice Address - Phone:775-220-6263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCI3167101YP2500X
NVCP5459101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional