Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | 4008 | LA |
Y | 1041C0700X | Clinical Social Worker | 4008 | LA |
NPI | 1003075623 |
---|---|
Provider Name | John Stanley Talley |
First Address | Baton Rouge, LA 70816-6038 |
Second Address | Bogalusa, LA 70427-3600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 04/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4008 | SOCIAL WORK EXAMINERS LICENSE (01) | LA |