Provider Demographics
NPI:1700159571
Name:TALIANCICH, MARK JASON (MA, PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JASON
Last Name:TALIANCICH
Suffix:
Gender:M
Credentials:MA, PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 GENERAL MEYER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3528
Mailing Address - Country:US
Mailing Address - Phone:504-453-7831
Mailing Address - Fax:
Practice Address - Street 1:1601 BARONNE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70113-1303
Practice Address - Country:US
Practice Address - Phone:504-206-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA9913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA9913OtherLICENSED PROFESSIONAL COUNSELORS BOARD OF EXAMINERS
LA4541OtherLICENSED PROFESSIONAL COUNSELORS BOARD OF EXAMINERS