Provider Demographics
NPI:1720135460
Name:TALBOTT, EVA L (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:L
Last Name:TALBOTT
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:L
Other - Last Name:VON SCHRILTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 RUSKIN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910
Mailing Address - Country:US
Mailing Address - Phone:719-572-6100
Mailing Address - Fax:719-572-6080
Practice Address - Street 1:115 S PARKSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910
Practice Address - Country:US
Practice Address - Phone:719-572-6340
Practice Address - Fax:719-447-4792
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4413101YA0400X
CO1677101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO128492Medicaid
CO37907344Medicaid