Provider Demographics
NPI:1265575013
Name:TALLEY, PAMELLA MOREDOCK (MA)
Entity type:Individual
Prefix:MRS
First Name:PAMELLA
Middle Name:MOREDOCK
Last Name:TALLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 NW DRAKE RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-2316
Mailing Address - Country:US
Mailing Address - Phone:541-389-2242
Mailing Address - Fax:541-389-5069
Practice Address - Street 1:965 SW EMKAY DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3033
Practice Address - Country:US
Practice Address - Phone:541-389-2242
Practice Address - Fax:541-389-5069
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health