Provider Demographics
NPI:1780735035
Name:TALLEY, DUANE ROGER (LPC)
Entity type:Individual
Prefix:
First Name:DUANE
Middle Name:ROGER
Last Name:TALLEY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-5317
Mailing Address - Country:US
Mailing Address - Phone:325-646-7783
Mailing Address - Fax:325-646-7783
Practice Address - Street 1:1801 14TH ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-5317
Practice Address - Country:US
Practice Address - Phone:325-646-7783
Practice Address - Fax:325-646-7783
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health