Provider Demographics
NPI:1639678113
Name:SUSAN TALMAGE, PHD, PA
Entity type:Organization
Organization Name:SUSAN TALMAGE, PHD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TALMAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:214-206-6822
Mailing Address - Street 1:20 VANGUARD WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-6510
Mailing Address - Country:US
Mailing Address - Phone:214-206-6822
Mailing Address - Fax:214-247-0632
Practice Address - Street 1:20 VANGUARD WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-6510
Practice Address - Country:US
Practice Address - Phone:214-206-6822
Practice Address - Fax:214-247-0632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-09
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
TX24635103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty