Provider Demographics
NPI:1770810202
Name:TALLEY, DEBRA LYNN (PSYD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYNN
Last Name:TALLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 366
Mailing Address - Street 2:
Mailing Address - City:TWISP
Mailing Address - State:WA
Mailing Address - Zip Code:98856
Mailing Address - Country:US
Mailing Address - Phone:509-429-0019
Mailing Address - Fax:
Practice Address - Street 1:111B TWISP RIVER RD
Practice Address - Street 2:
Practice Address - City:TWISP
Practice Address - State:WA
Practice Address - Zip Code:98856-9787
Practice Address - Country:US
Practice Address - Phone:509-429-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY60114590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical