Provider Demographics
NPI:1134255268
Name:TALBOT, BARBARA ELLEN (PHD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ELLEN
Last Name:TALBOT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7386 RADCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3535
Mailing Address - Country:US
Mailing Address - Phone:248-540-2220
Mailing Address - Fax:248-723-4766
Practice Address - Street 1:31000 TELEGRAPH RD
Practice Address - Street 2:SUITE 150
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4360
Practice Address - Country:US
Practice Address - Phone:248-540-2220
Practice Address - Fax:248-723-4766
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005276103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0F34752Medicare ID - Type Unspecified