Provider Demographics
NPI:1487755716
Name:TALLANT, ANNA MARIE (LMHC NCACII)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:TALLANT
Suffix:
Gender:F
Credentials:LMHC NCACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:131 N PENDLETON AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PENDLETON
Mailing Address - State:IN
Mailing Address - Zip Code:46064
Mailing Address - Country:US
Mailing Address - Phone:765-778-3223
Mailing Address - Fax:765-778-3223
Practice Address - Street 1:131 N PENDLETON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064
Practice Address - Country:US
Practice Address - Phone:765-778-3223
Practice Address - Fax:765-778-3223
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001561A1041C0700X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor