Provider Demographics
NPI:1336588904
Name:TALLEY, LYDIA B (LPC-S, NCC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:B
Last Name:TALLEY
Suffix:
Gender:F
Credentials:LPC-S, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 YMCA PLAZA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-0939
Mailing Address - Country:US
Mailing Address - Phone:225-287-6856
Mailing Address - Fax:225-767-5051
Practice Address - Street 1:8235 YMCA PLAZA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-0939
Practice Address - Country:US
Practice Address - Phone:225-287-6856
Practice Address - Fax:225-767-5051
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4548101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional