Provider Demographics
NPI:1740722099
Name:CAMBRON TALBOTT COUNSELING
Entity type:Organization
Organization Name:CAMBRON TALBOTT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:CAMBRON-ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-210-3055
Mailing Address - Street 1:2000 W PIONEER PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1883
Mailing Address - Country:US
Mailing Address - Phone:309-210-3055
Mailing Address - Fax:
Practice Address - Street 1:2000 W PIONEER PKWY STE 3
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1883
Practice Address - Country:US
Practice Address - Phone:309-210-3055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-16
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty