Provider Demographics
NPI:1245990852
Name:TALLEY, NIKI LEE (LCPC)
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:LEE
Last Name:TALLEY
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 1:400 W MAIN ST STE 203
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2443
Mailing Address - Country:US
Mailing Address - Phone:406-360-1462
Mailing Address - Fax:
Practice Address - Street 1:400 W MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2443
Practice Address - Country:US
Practice Address - Phone:406-360-1462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-22
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT53665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health